At what point is this a problem?

[Eunoia]

At what point are you considered an alcoholic? Do you have to drink a certain number of drinks in a particular time span (ie. binge drinking)? Is it only after it interferes with your life in terms of work, relationships, mood etc? What about those people who use alcohol as a means to cope when they do drink, but are otherwise fine? What about consuming excessive amounts of alcohol for the same purpose? Is this just a bad coping mechaninsm or is it an actual problem?

 

[David Baxter PhD]

I think it's a rather blurred and imprecise distinction, Eunoia. DSM-IV-TR doesn't use the term "alcoholism" but instead refers to "Abuse" and "Dependence". Usually, when I'm talking to clients or families, I'll use the term "problem drinking", which is less judgmental.

I think there are probably a lot of things which may define problem drinking - you've mentioned many of them.

DSM-IV-TR says

When repeated use of alcohol or other drugs leads to problems but does not include compulsive use or addiction, and stopping the drug does not lead to significant withdrawal symptoms the term substance abuse applies.

A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household)
(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)
(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of Intoxication, physical fights)

B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

On the other hand, Dependence is:

When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped.

A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

(1) tolerance, as defined by either of the following:
(a) a need for markedly increased amounts of the substance to achieve Intoxication or desired effect
(b) markedly diminished effect with continued use of the same amount of the substance

(2) Withdrawal, as manifested by either of the following:
(a) the characteristic withdrawal syndrome for the substance (refer to Criteria A and B of the criteria sets for Withdrawal from the specific substances)
(b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance (e.g., chain-smoking), or recover from its effects

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

Specify if:

With Physiological Dependence: evidence of tolerance or withdrawal (i.e., either Item 1 or 2 is present)
Without Physiological Dependence: no evidence of tolerance or withdrawal (i.e., neither Item 1 nor 2 is present)

 

[Eunoia]

would you excuse a person's behaviour as a result of being drunk in order for them to deal/cope w/ something? even if this doesn't happen a lot but if it does it is very damaging emotionally, then do you sit there w/ the person, helping them out, excusing their behaviour b/c you know they're in pain, or do you even have a right to be mad and upset b/c it's causing even more pain and there are other ways of coping? I'm not trying to say a person who copes by drinking is a bad person, as I understand the difficulty of getting out of that cycle, but what do you do when you're on the other side of the table? is it really as simple as the event happening and then it is never talked about again afterwards, b/c it's easier just to forget about it?

 

[Lana]

Drinking oneself into oblivion as a means to cope with pain is not a good thing. It is NOT dealing with the issue, it's adding to the issues. Personally, most of my friends know that I can't and won't deal with intoxicated persons, nor do I accept excuses for such behavior. Because of that stance, I never had any issues with someone that drinks. What would be the difference if they substituted alcohol with some other substance? None, except for the symptoms/affect on their bodies.

I know it may seem extreme on my part. My feelings towards that began when I was (I think, can't remember exactly) 6 or 7 years old and my mother left me in the room with a very drunk woman, who began to convulse and throw up. It was 3 am and I was so frightened, that I walked out of the apartment and went to a neighbour and asked them to take me in because I was so afraid. Needless to say it freaked my mother out. And yes, they were all full of excuses but I have never been able to deal with anyone under severe influence since. LOL. One night my husband came home intoxicated after night out with the boys. I did the same thing (at about 3am), I got dressed, called a friend and left. He felt so bad (physically and emotionally) that he never did that again.

 

[poohbear]

problem drinking

I agree with lana. i, too, will not tolerate drinking. i have never been drunk. I have never tried/used drugs. believe me, i grew up in situations where it would have been so easy to turn to drugs and/or alcohol for relief, and as an adult, trying to deal with it, sometimes i think drugs would be a better option. but i know that using would make me...not me. drugs/alcohol have a physical effect upon the body, a chemical effect. it will wither be a depressant or a stimulant. (god knows, i'm depressed enough already, and my repressed anger can stimulate napoleon's army into action...) what's the point of either stimulating or depressing your body? people use to "capture the moment" or the "feeling". i suppose they don't understand, or care at the moment, that the feeling passes, and then they're stuck with the bodily responses. i believe a problem exists when it interferes with your normal everyday life, or if it damages your body in any way. the way some people drink, i'm surprised they haven't been dx'd with kidney/heart/liver disease earlier, or that the problems associated with drinking and drugs aren't more readily publicized. when's the last time you saw a health advisory on television with a 55 year old man on dialysis telling of his "glory days" that damaged his liver, which put excess strain on his kidneys/heart, and now he's on dialysis three to four times a week b/c he's not a good candidate for a transplant. translation: death sentence. Or a pregnant woman in a bar drinking and smoking--flash forward to the delivery room where her baby is born prematurely at 24 weeks-- a full four months before gestation is complete and too soon for the lungs to have develped properly. baby's on a ventilator, has an iv in the head, neck and groin. tube feedings. heart monitor, warming blanket (b/c it's too small to keep it's temp. regulated alone). baby will grow up permanently disabled, if he survives at all. i guess it's not politically correct to capture these images and put them on television for the public to see. but i believe they need to know, and early. parents need to discuss drugs and alcohol with their children early and often to prevent abuse and to protect our youth.--poohbear

 

[kelsischanging]

As a person who is only one step one of the 12 steps of AA...I can tell you that drinking is not an effective nor a healthy coping mechnanism....also you ask if it was ok if the person only drinks excessivly when they need to cope...trust me...I'm not a professional or anything but I am an addict and an alcoholic(it was only yesterday that I was able to say that outloud) ...eventually whether that is five months or five years the alcohol will start to sneek into other areas of their life...they will find it more and more difficult to cope w/out alcohol and then all of a sudden life becomes more and more stressful and then you need to cope more and more but it's becoming almost impossible to cope w/out alcohol...basically what I'm saying is that if you don't think you (or whoever you're talking about) is an alcoholic or if you see yourself abusing or are dependent on alcohol it sounds like there is something going on w/ alcohol and I would say get help before it becomes anymore of a problem...

 

[just mary]

Hi Eunoia,

I liked your inital question, "At what point are you considered an alcoholic?". I've grappled with it also and I'm still not sure what an alcoholic is. I go to AA and at every meeting I say I'm an alcoholic. I know I have a drinking problem but I was never physically dependent on alcohol. And I know there are many others similar to me. The word "alcoholic" has different meanings for different people. It's meaning is driven by our culture at the time. If you asked someone 50 years ago "What's an alcoholic?", the answer would probably be very different than if you asked someone the same question today. At AA, the term alcoholic is used for anyone who thinks they have a drinking problem, so I'm an alcoholic at AA. I know some people would disagree. But I definitely abused alcohol, I drank because it made me feel good (for awhile) and my hangovers were never that bad (at the beginning, they steadily got worse).

As for dealing with the behaviour of an alcoholic, I don't think you should excuse it or sweep it under the rug. If they have hurt you in any way, you should let them know it, you have every right to be angry. If they haven't hurt you but you're finding it difficult to watch them hurt themselves, tell them. You might even try going to an Alanon meeting and talking with others who have been in the same position.

Looking back, I appreciated the people who told me that I had a problem, I never acted on their comments until much later in life but it did plant a seed and it made me think. And I wish I had listened sooner but alcoholics tend to be selfish and can't see beyond themselves. And now I'm using that word again.

Anyway, I wish you all the best Eunoia.

Take care,

 

[ThatLady]

I agree with what others have said here. Drinking oneself into oblivion is not a coping mechanism. It's a cop-out. It's a method to avoid coping, and it doesn't even do that well. The problems you're having trouble coping with are still there when you sober up.

Those who are confronted with the behaviors of someone abusing alchohol have every right to turn around and walk away. To stay, holding their little hands and listening to their maundering stories, isn't helping. It's just enabling them to excuse their drunkeness and expect others to excuse it, as well. Not only that, but the alcohol is slowly killing them. If you stick around, you'll be there for those final moments...believe me, they ain't pretty.

 

[David Baxter PhD]

Drinking oneself into oblivion is not a coping mechanism. It's a cop-out. It's a method to avoid coping, and it doesn't even do that well. The problems you're having trouble coping with are still there when you sober up.

No, I don't think it's a cop out. It is often a coping mechanism - admittedly not a very effective one and one that causes more problems than it solves even temporarily, but I'm not sure it's fair to condemn someone who has a drinking problem.

I would agree that anyone with any kind of substance abuse problem, whether it's alcohol or drugs or cigarettes, is not going to change until s/he first perceives that it IS a problem and second decides s/he wants to do something to change it. If you're living with someone, don't expect that person to change for you - s/he has to get to the point where s/he is changing for herself/himself.