Further Reading

Are people alcoholics if they think they are?

Dear Stanton:

....I am simply drawing a conclusion from various phenomena that you describe and that I have observed. People enter alcoholism treatment for various reasons, including (usually coercive) referrals from family, friends, EAPs, and courts, and thence they are referred to AA, where self-description as an alcoholic is the ticket to admission. (I concentrate on the word "alcoholic" because you have already explained your stance on the word addiction and alcoholic seems, perhaps deceptively, to be capable of tighter definition. Treatment centers certainly are motivated to detect as many alcoholics (or addicts) as possible, both for economic reasons and evangelical ones. This introduces a great deal of uncertainty into the definition. Further uncertainty is introduced when someone scores differently on AA's Twenty Questions, for example, from on the MacAndrew Scale.

You seem to have put a slightly different slant on my question than I intended. I was not focusing on the rise in alcoholism, although I don't deny that there are lots of people in pain out there. The treatment community, having identified such a person who drugs or drinks, will not look farther. A prominent doctor here in town recently surmised (not publicly) that he had misdiagnosed several manic depressives as alcoholics or addicts, simply because he had not looked beyond their presenting behaviors. Hence we see a rise in substance abuse, at great cost to both those misdiagnosed individuals and the community that could have benefited from their contributions.

My question, however, was what do you mean when you use the words "alcoholic" and "alcoholism"? In reviewing Vaillant's and Blum's books, for example, are you using their definitions? (Do they use the same ones? Do they define these words at all?) Are you looking to the DSM? MacAndrew Scale? Twenty Questions? Any other set of questions a treatment center may have devised? Self-description (whether or not contaminated by a previous diagnosis)? It is clear to me from your writing and from my own experience that these words mean different things to different people, and we may engage in a dialog using these words without realizing that we are not talking about the same thing at all.

What do you do for a living? Are you a researcher, an academic, or just a personally interested individual?

In a sense, my definition of alcoholism is more permissive and more common-sensical. I believe it is a largely subjective phenomenon -- and so, when people say they can't control their drinking, even when in fact they have been persuaded of this in treatment, I say they are alcoholic. My evidence for this is that in several direct comparisons, subjective self-characterizations of a drinking problem were better predictors of outcomes (CD v. abstinence) than were "objective" assessments (See Alcoholism, Politics, and Bureaucracy or Why do controlled-drinking outcomes vary by investigator, by country and by era. The recent failure of Project MATCH to successfully predict that objectively characterized alcoholics will fare better on appropriately matched treatments is another consequence of the misconception of definitions of alcoholism that omit subjective perspectives. Indeed, this is the entire point of my book, The Meaning of Addiction.

However, since I don't see this as an inbred trait, but a flexible self-characterization, changing perpsectives, situations, and behaviors can readily remove a person from the alcoholic category -- more so than seems possible with "objective" medical or other definitions of alcoholism.


Further reading:

Why do you use "Addiction" in the title of your web site?