Alcoholic? That's so 1980s
... and not in a good way.
The word "alcoholic" has been adopted by countless individuals across the globe, and for nearly a century has been the mainstream term used to describe someone with a drinking problem.
But regardless of how much someone drinks or used to drink, it's not a word I use for myself or anyone else - and here's why.
The Medical Community Doesn't Use It Either
Alcoholism was first coined in the mid-19th century and was used to describe a "disease" whereby the person drank despite negative consequences.
In the US, as well as in countries around the world, medical professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental disorders. This manual, published by the American Psychiatric Association, was first published in 1952 and has been updated several times. In that first edition, alcoholism was described as a "well-established addiction to alcohol without [a] recognizable underlying disorder”.
Then, in 1980, the DSM split alcoholism into 2 separate diagnoses: alcohol abuse and alcohol dependence. The most recent terminology recognizes a spectrum of problematic behaviors, which is now called Alcohol Use Disorder.
Around the same time, the choice to abandon the term alcoholism for more specific and less stigmatized terminology was matched by the World Health Organization in their International Classification of Diseases (ICD), which classifies diseases by assigning them particular diagnostic codes.
It has been over 40 years since the medical community used the term alcoholism as a medical diagnosis, and yet colloquially it still dominates. Interestingly, the early 1980s was also when GRID (Gay-Related Immune Deficiency) was renamed AIDS (Acquired Immune Deficiency Syndrome), a name broadly accepted in current society. Although the term alcoholism is not nearly as stigmatizing as a disease name that blatantly calls out a group of people based on their sexual orientation, medical professionals across the globe have concurred that the term does not appropriately or fairly describe alcohol abuse, and I prefer to follow their lead.
It "Others" People
If you had asked me a couple of years ago what an alcoholic looked like, my mind would immediately have gone to a person on the side of the road drinking from a paper bag. Or perhaps to someone with at least one DUI or other legal issue, someone with strained relationships and on the cusp of losing their job.
That wasn't me. I wasn't an alcoholic. Work was great; I was quickly moving up the ladder in my career. My relationship with my husband was strong, I didn't get the shakes if I didn't drink, and my blood tests always came back normal.
And yet:
were there times I ended up drinking more than I planned? Yep, on occasion that "just one beer!" turned into 2. Or 4.
did I try to cut down more than once and fail? Just about every week I made rules about when and where I could drink... and then broke them.
did I keep drinking even though I had blacked out at least once in the past year? Sure, but I learned my lesson, I won't be drinking that much again.
did I need to drink more than I used to to get the same effect? Yep. Sometimes it felt like no matter how much I drank, I couldn't get the effect I was looking for.
did I ever have withdrawal symptoms after drinking, like nausea or sweating? Sure, but doesn't everyone have mornings like this on occasion when they drank too much the night before?
did I spend a lot of time drinking? Maybe not ONLY drinking. But I drank on date nights. I drank on weekends. I drank after work sometimes, especially if it was a particularly hard day. I drank when we went out to restaurants. I drank to celebrate. I drank at the movie theater, or at concerts, or at a show. I didn't drink all day long, or sneak drinks at work or anything. But a lot of my free time was spent in a way that somehow involved drinks.
These things didn't seem all that crazy to me. In fact, I would guess that most drinkers have at least one of these in common with me. But according to the DSM-V (the latest version), saying yes to those points above meant I had SEVERE Alcohol Use Disorder.
I was convinced I wasn't an alcoholic because these behaviors didn't match the picture I had in my head, and yet medical professionals would say that my behavior was on the far end of the alcohol abuse spectrum.
By using a word like alcoholic, which lumps all problematic drinking behaviors under one term (generally the worst-case scenario), it was easy for me to argue that I "wasn't that bad" and therefore didn't have to take a closer look at my behavior. I wasn't "one of them", so I was fine.
When we use scary words like "alcoholic", which drum up the picture of the person whose life is falling apart and who can never drink again, it discourages people from considering whether their behavior around alcohol is problematic in its own way.
It Reduces The Person To A Set of Behaviors
By declaring yourself (or someone else) an alcoholic, you are defining who you are as a person by your current or past set of behaviors. In essence, you are applying a label that historically cannot be removed; you can only be a "recovering" alcoholic, not someone who used to have this "disease" and now doesn't.
Let's say you subscribe to the "disease" model of alcoholism and believe that it is something you can never get rid of - you and your body simply cannot handle alcohol the way others can. A helpful comparison here is Type 1 diabetes. There is no cure for this disease - your body simply cannot make enough insulin or use it as efficiently as others can. And yet the CDC recognizes that the preferred terminology in this case is a "person with diabetes" over diabetic, which implies that they ARE their disease. In the same way, the "disease of alcoholism" is something that you HAVE, not who you ARE.
And what if you used to drink heavily, but haven't touched alcohol in 20 years - why does that past behavior need to continue to define you? I don't talk about this often, but in high school, I would often eat only one meal a day; I'd tell my parents I was going to grab breakfast at school or on the way, and I'd skip either lunch or dinner depending on whether my parents would be home that evening to notice. I've always carried extra weight around my belly, and I wanted so badly to be like those skinny popular girls with the flat tummies.
Was this disordered eating? Absolutely. ( I think now it would be called Avoidant/Restrictive Food Intake Disorder or possibly Anorexia Nervosa). Do I do this anymore? Absolutely not, not for decades now. I do not always eat healthy meals - I like to occasionally indulge as much as the next person - but I do not have extreme and unhealthy rules around my food intake. To say that I am an anorexic or recovering anorexic at this point would be ludicrous.
Don't Call Me An Alcoholic
But go ahead and call yourself whatever you want! Just as I don't like the word alcoholic because it creates an us vs. them mentality, it is exactly this reason that some people prefer it. By self-identifying as someone who is somehow different than "normal" people, it can help strengthen the attachment to a group, and belonging is a fundamental human need.
It may also help keep you on your desired path. If you believe that this word describes who you are (and always will be), it can cement in your mind that drinking can never again be an option for you.
It can be hard to change the lexicon in this area, especially when one of the most prevalent forms of treatment has "alcoholic" right there in the name. But I think it is important for all of the reasons above and more. So if the word alcoholic doesn't sit right with you, don't use it! It's perfectly okay to decide that you want to change your habits without adopting an outdated label. And it is certainly not a prerequisite to get support, at least not from me ❤️
