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What is the definition of alcoholism?
Is alcoholism a disease?
When someone is an alcoholic, why canít they just stop drinking, or drink less?
How do you know if you have a drinking problem?
How do you know if you are an alcoholic?
How can parents help their children avoid alcohol or addiction problems?
What is the difference between 12-step, self-help groups like AA, and professional addictions treatment?
What are the key ingredients for successful recovery from alcoholism?
Is there an addictive personality?
I think I might have a drinking problem. What should I do?

Related Topics

Addictions
Drug Addiction

Alcoholism FAQs

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.


Alcoholism is a broad term that describes significant problems with alcohol use.   It is not a diagnostic term recognized by the American Psychiatric Association.  Nonetheless, it a commonly used term that generally includes an impaired ability to limit alcohol use, despite the harmful consequences of continued use.  In this respect, alcoholism meets the definition of addiction.  In our topic center on addiction, we define addiction. 

Addiction is the repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

This definition includes four key components:

1. Addiction includes both substances and activities (such as sex and gambling).
2. Addiction leads to substantial harm.
3. Addiction is repeated involvement despite substantial harm.
4. Addiction continues because it was, or is pleasurable and/or valuable.

You can read more about this definition of addiction in the article entitled, What is alcoholism?.

 

There are at least four primary ways to understand alcoholism:

1. Alcoholism is a biological problem.
2. Alcoholism is a psychological problem.
3. Alcoholism is a social or cultural problem.
4. Alcoholism is a spiritual problem.

You can learn more about these four ways to understand alcoholism in the article entitled, What causes addiction.

Recent research suggests the causes of addictions, such as alcoholism, are heavily influenced by our biology.  When viewed in this manner, alcoholism is sometimes called a disease.  However, there is no medical "cure" for alcoholism.  Yet, every day people recover from alcoholism.  The different ways that people recover from alcoholism rely on psychological, socio-cultural, and spiritual solutions.   Therefore, viewing alcoholism as a disease is too simplistic. When alcoholism is viewed as a disease, there is one dividing line.  Either you have a disease, or you do not.  However, we know people experience varying degrees of difficulty with alcohol ranging from none to severe.  Additionally, people may experience alcohol problems during different periods of their life. A disease concept of alcoholism does not account for the full range of alcohol-related problems that may come and go as people move through their lives.  Similarly, it does not account for the many non-medical solutions to recovery from alcoholism. 

 

Of course, people do indeed stop, but it can be quite difficult for a number of reasons.  Some of these reasons are due to the way addictions, such as alcoholism, cause changes to the brain.  Stopping an addiction requires significant behavioral change.  Behavioral change of any sort can be quite difficult.  There are psychological reasons for this difficulty. For more information, see the article entitled, How do you get addicted to alcohol?

You may also be interested to read more about addiction and the perceived loss of control in our addictions topic center.

 

Alcoholism is a specific type of addiction. Like all addictions, there are varying degrees of severity. Note that the American Psychiatric Association's Diagnostic Manual, DSM-5 (APA, 2013) does not use the word alcoholic. As such, it has no diagnostic meaning. Nonetheless, most people are familiar with the term "alcoholic." It is often used to describe severe alcohol use disorders. Risky or problematic drinking occurs long before this level of severity and most certainly does require attention.

Alcohol is the most widely used (and overused) substance (drug) in the United States. The majority of people who drink are able to drink in moderation. We might call these people occasional, light, or moderate drinkers. They have never met diagnostic criteria for an alcohol use disorder. However, about 7% of the people in the United States DO meet these diagnostic criteria (NIAAA, 2004; Miller, Forcehimes and Zweben, 2011). In addition, about 20% of men and 10% of women drink more than the recommended moderation guidelines. The interested reader may find it helpful to review these guidelines published by National Institute on Alcohol Abuse and Alcoholism:

http://rethinkingdrinking.niaaa.nih.gov

The identification of problematic or "risky" drinking is a complex one. This is because individual drinking patterns change over time. Moreover, many of the people in the "high risk" category do not consider themselves "alcoholic." Therefore, they falsely conclude they do not need to pay attention to their drinking (Doyle & Nowinski, 2012).

Moderation guidelines are based on the number of drinks per day, and the total number of drinks per week. A drink equal a 12 oz. beer, or a 5 oz. glass of wine, or a 1.5 oz. shot of liquor. For men, the maximum limits are: a) no more than 4 drinks in a day, and b) no more than 14 drinks per week. For women, the maximum limits are: a) no more than 3 drinks in a day, and b) no more than 7 drinks per week. For some people moderation is extremely difficult to maintain. They end up over-drinking. These people may go on to develop an alcohol use disorder. Withdrawal from alcohol use can begin 4-12 hours after stopping or reducing heavy use. Symptoms of alcohol withdrawal are often extremely unpleasant. It may include sensations such as sweating; tremor; insomnia; nausea/vomiting; hallucinations; agitation; anxiety; and even seizures. In severe and untreated cases, alcohol withdrawal may result in death. Consult with a physician prior to discontinuing heavy alcohol use.

 

There are at least two ways to decide whether you might be an alcoholic: 1) a formal diagnostic assessment performed by an addictions specialist, or 2) an informal self-assessment. 

Alcoholism is a specific type of addiction.  To perform an informal self-assessment you can use the definition of addiction and evaluate your own behavior according to this definition.   In our topic center on addiction, addiction is defined as:

Addiction is the repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

In the section entitled, What is alcoholism? we listed the many types of substantial harm that meet this definition of addiction.  You could use this list to decide if your drinking behavior meets this definition of addiction.  Addiction differs from "behavin' badly" because it means someone is repeatedly involved with a substance or activity despite substantial harm. 

The second way to decide if you have an addiction to alcohol is to request a formal assessment by an addictions specialist.  If you are concerned about the possibility having any type of addiction problem, it may be wise to ask your healthcare provider or EAP specialist for some guidance.   They can refer you to an addictions specialist who will help you make an accurate assessment. 

 

A leading and highly respected addictions expert, Stanton Peele (2007) has suggested that a guide for raising children to become moderate, not excessive, drinkers can be found by observing the cultural norms of the Italian, Spanish, French, Greek, Jewish, and Chinese cultures. Relative to the United States, these cultures have very low rates of alcoholism.   In these cultures, children are socialized into approved, moderate, and social drinking.  This means drinking occurs with meals, and during celebrations and religious ceremonies.  Furthermore, children are socialized to disapprove of drunkenness.  

How well this recipe would translate to other cultures, or to a specific family, would depend on many factors.  SAMHSA (2011) reported that adults aged 21 or older who had first used alcohol at age 14 or younger were more than 5 times as likely to be classified with an alcohol use disorder than adults who had their first drink at age 21 or older (15.1 vs. 2.7 percent).  Given these statistics, a family in the United States would need to carefully consider several questions.  Can a typical American family environment sufficiently influence children toward moderation, as is done in some European countries or Jewish culture?   Is the family's influence powerful enough to supersede the larger cultural acceptance of alcohol misuse and drunkenness?  Parents should be sure to check the laws in their own state regarding parents serving alcohol to their own children.

More information about protecting children from alcohol and other drugs is available here.

 

First, there are two basic types of self-help support groups:

1. Self-empowering support groups.
2. 12-step support groups

Addiction is similar to many other types of problems. Some people require professional assistance, while other people do not. 12-step groups (e.g., AA) are non-professional groups. One of the primary differences between 12-step groups and professional treatment is the issue of confidentiality. Professional healthcare providers are required by law to maintain confidentiality. No such assurances exist in non-professional groups. Another significant difference is that professional healthcare providers rely on science and research to guide their methods. 12-step support groups rely on spiritual solutions. These differences have led to a great deal of unnecessary controversy between supporters of science and supporters of 12-step groups. It is perfectly fine to integrate spiritual and scientific solutions. We developed a guide to help you set up your own personal program of recovery.

 

There are four key ingredients for successful addictions recovery. This is true whether someone is attempting independent recovery, or relying on professional help. These are:

1. Humility
2. Motivation
3. Sustained effort
4. Restoring meaning and purpose to life

Of these, motivation is perhaps the most essential. It is important to note that motivation can be strengthened. So, even if someone is initially unsure about whether they want to give up drinking, they can increase their own motivation by a realistic appraisal of the costs and benefits of continuing drinking versus quitting. One technique that helps people make an accurate appraisal is called motivational interviewing. You can read more about these four key ingredients and motivational interviewing in this article.

 

Personality refers to a unique and enduring pattern of thinking, feeling, and behaving.  Contrary to popular belief, research has been unable to identify an "addictive personality." However, some personality traits are more commonly observed in people with substance use disorders such as alcoholism.  Most of the research regarding addiction and personality traits has been conducted with people who have alcohol use disorders. Nonetheless, we observe many of these traits in people with other substance use disorders as well.  The most common of these personality traits include nonconformity; impulsivity; sensation- or thrill-seeking; negative affect (e.g., depression, anxiety); low self-esteem; and an external locus of control.

 

There are many different types of help available from self-help groups to professional treatment. We have created a personal action plan for recovery for those people who would prefer the self-help approach. We have also developed guidelines for choosing treatment options for those people who prefer professional assistance. The most important thing to do is take some action, rather than just wondering about it. Although thinking about a problem usually precedes doing something about it, the bottom line is that action is what creates the desired change.