Is it Alcohol Use, Abuse, Binge Drinking, or Addiction?
Allen Carr issued the following statement in his 2005 book “The Easy Way to Stop Drinking”:
“Normal drinkers are in an earlier stage of the same disease.”
But is this true? Well, we know that not every casual drinker turns into an alcoholic. But we can’t deny that everyone who drinks alcohol is doing it for a reason. And it’s almost never a good one.
According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), 1 in 12 adult Americans is considered an alcohol abuser or alcoholic. But what is the difference? And where does the scale for alcohol use begin and end?
What is a “normal” drinker?
According to the NIAAA, the guidelines for drinking should be limited to 1 drink per day for women, and 2 for men. Something around this figure would be considered normal drinking behavior by many.
Low-risk drinking is considered to be no more than 3-4 drinks on any single day and no more than 7 drinks per week for women and 14 for men.
NIAAA research has shown that only about 2% who drink within these limits have an alcohol use disorder. Those who do may have other issues such as drinking too quickly or exacerbating health problems.
What is binge drinking?
The NIAAA defines binge drinking as “a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.”
In addition, the Substance Abuse and Mental Health Services Administration (SAMHSA) defines binge drinking as drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past month.
What is “heavy drinking”
SAMHSA defines heavy drinking as drinking 5 or more drinks on the same occasion on each of 5 or more days in the past month.
So, if someone is bingeing and/or drinking heavily, do they have an alcohol use/abuse disorder, or are they an alcoholic? Some point to additional factors.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
In the previous edition (IV) of the DSM, there were two distinct categories of alcoholism, if you will. Alcohol Abuse and Alcohol Dependence. The former implies just what it says – overuse and abuse. The latter implies addiction, or what you might call true alcoholism.
However, in the current edition (IV) of the DSM they have been integrated into one category: Alcohol Use Disorder (AUD). Within this category are mild, moderate, and severe classifications. This idea appears more or less in line with Allen Carr’s thinking when he said that all drinkers are suffering from the same disorder, its just a matter of what extent.
Is it abuse or addiction? Or something in between?
For example, some believe that the DSM sub-classification of mild AUD as being abuse, and moderate-heavy as being more exemplified by dependence, or addiction.
Alcohol addiction can be defined as being a chronic disease which includes a psychological and physical dependence on alcohol.
Other commonly accepted characteristics include tolerance, the presence of significant withdrawal symptoms upon cessation of use, cravings, and a general loss of control over drinking habits.
Some believe that one of the signs of addiction is the inability to moderate use despite the negative consequences. Moreover, the reward pathways in the brain which are affected by alcohol undergo irreversible changes. These changes are severe enough to encourage the user to place drinking alcohol above other activities, friends and family, and general life responsibilities.
The Alcohol Continuum
For example, some who are severely dependent upon alcohol may face life-threatening withdrawals if they suddenly stop. However, many daily drinkers can quit and not face those effects.
Also, some alcoholics are high-functioning. They go to work or school, and behave relatively normally much of the time. Others drink constantly throughout the day. and literally cannot function without it.
Furthermore, binge drinking can come and go. I’ve seen people go years and then tie one on. There’s no predicting it.
And for those who say a drink is a drink is a drink, I would beg to differ. Many alcohol abusers have their drink of choice, and abstaining from that drink can make a big difference in their use. For example, I’ve witnessed regular hard liquor drinkers go back to beer without suffering the same abuse problems. However, if they go back to drinking liquor, all bets are off.
The Myth of Normal Drinking
I’m in same camp as Mr. Carr. I don’t think any drinking is really “normal”. And I can say that because I’m an alcoholic of sorts. I also understand a lot about how alcohol affects the brain and human behavior.
I do think that the human desire to seek out psychoactive substances is understandable. However, I’ve never heard of anyone utter a good reason for drinking. It’s always to feel more social, to cope with life problems, or to enhance feelings of euphoria and inhibition.
Moreover, it’s not like why people want to use ayahuasca. It doesn’t open up any magic doors to the nature of our existence.
And another problem is, alcohol doesn’t really do any of those things. The dopamine released in our brains upon consumption makes us think that, but its not really true. If it were, humans could not be social, feel good, or cope well with life without it.
And the truth is, we can – and we do it much better sober.
~ G. Nathalee Serrels, M.A., Psychology