An alcoholic researcher's perspective on alcohol research

Most researchers have a habit of putting themselves under the microscope. “Mesearch,” it’s called. It’s when the person with an eating disorder studies disordered eating. The survivor of abuse devotes his whole life to understanding what could've prevented it. The woman from Mexico tries to understand what culturally competent counseling could look like for her daughter.

I make an exception for alcoholics. I’ve met a lot of alcoholics, and a lot of researchers, and never once have I meant a researcher who both identifies as an alcoholic and studies alcohol use disorder in her professional life.

And if I'm being honest, the research itself kind of looks that way. I'm not sure that anyone doing research on alcoholism actually has the disease.

Case in point: When I type "alcohol use intervention" into PubMed and filter on the last five years, the following research articles pop up:

"A structured telephone-delivered intervention to reduce problem alcohol use (Ready2Change): study protocol for a parallel group randomised controlled trial"

"Smartphone-based, momentary intervention for alcohol cravings amongst individuals with an alcohol use disorder"

"Family-based prevention programmes for alcohol use in young people"

If you're an alcoholic, maybe you're already raising your eyebrows at these tiles. If not, here's my own immediate, uncensored thought process:

Them: "A structured telephone-delivered intervention to reduce problem alcohol use (Ready2Change): study protocol for a parallel group randomised controlled trial"

Me: When I was drinking, I would not have answered a phone call from a stranger imploring me to stop drinking, let alone changed my habits because of it.

Them: "Smartphone-based, momentary intervention for alcohol cravings amongst individuals with an alcohol use disorder"

Me: I know people for whom the threat of losing their home, their husband, and their child wasn't enough to beat a craving - much less a push notification from their smartphone.

Them: "Family-based prevention programmes for alcohol use in young people"

Me: If a future alcoholic isn't exposed to alcohol by the family at 12, they will be exposed by friends at 18 or their book club at 30. Most of the time, alcoholics find alcohol.

In short, when I skim through the latest research on alcoholism, I wonder if anyone writing has even met an alcoholic, let alone identifies as alcoholic themselves.

There is a trend in academic writing - one that never quite caught on - where the researcher takes a paragraph to name their own identities, to describe the way in which those identities might have influenced their research questions or interpretations of the results.

Part of me hates this idea. No one could reasonably name their every experience that went into shaping a certain perspective. No one is objective enough to name precisely how their experiences make them less objective. And even if we could do that: beneath our most salient identities and experiences, we're not just blank slates, ready to objectively behold research. We're still there. The goal of "getting all our biases on the table" feels at once misguided and impossible.

And yet: if I were ever to conduct research on alcoholism, my identities and experiences would go a long way to explaining the questions I asked and my interpretation of the results. Indeed, the very words I use would need explanation; in clinical and research settings, "alcohol use disorder" is the accepted term, and the term "alcoholism" is seen as stigmatizing, outdated, and imprecise. In the twelve step groups where I recovered, differentiating between "mild" and "moderate" alcohol use disorder would be entirely beside the point. We're just alcoholics.

And it isn't just the words we use. The fact that I recovered using the twelve steps means that the solutions laid out by researchers are unrelatable. Phone calls, push notifications, sitting the family down to have a chat about healthy coping. (To be fair, that last article bore out my suspicion: researchers analyzed 40,000 participants across 46 separate studies and found that family based prevention programs are pretty much useless.)

In contrast, when I got sober, I changed my friend group, my hobbies, and started going to recovery meetings almost every day. I did the readings, got a sponsor, worked the steps. I was told - and indeed, it helped me to believe - that doing anything less would result in relapse.

My face when I hear the phrase "brief alcohol use intervention"

A few months ago, I spoke with another researcher in recovery on this very topic. When she reviews research proposals or papers, she cringes seeing the latest-and-greatest interventions for alcohol use disorder. "That doesn't mean the interventions won't work," she reminded me. "It just means that I'm too close to the problem to see it."

She's right. The truth of all this is horribly mundane (read: nuanced). For some people in recovery, "alcohol use disorder" is just the right term. For some with only mild alcohol use disorder, the problem might resolve without ever progressing to "moderate" or "severe" use. And for some of those who do progress towards severe alcohol use disorder, perhaps a push notification or a phone call is exactly what they need. We don't know; that's why some researchers choose to ask.

I can't imagine these solutions, but here's what I can imagine. After years of battling the constricted perspective that comes with mental illness, I can imagine being too close to a problem to see the full range of solutions. I can imagine that others have something to teach me. Thankfully, I can imagine being wrong.


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