Am I An Alcoholic?

Anyone who is in long-term recovery from alcoholism has at some point had to do some deep searching within themselves to find an answer to this question. People can become obsessed with knowing, “am I an alcoholic or do I just really like to drink”?  For many, they won’t seek help until they know the answer to this question.

Understanding the terminology used by the psychiatric, medical, and addiction fields can help to clear up confusion one might have which can help them determine if they are an alcoholic or not. The DSM-V (Diagnostic and Statistical Manual – 5th edition) created by the American Psychiatric Association lists the criteria used to determine how severe someone’s drinking problem may be. The terminology used for a “drinking problem” is “Alcohol Use Disorder” (AUD).

The severity of the AUD is defined as:

Mild: The presence of 2 to 3 symptoms
Moderate: The presence of 4 to 5 symptoms
Severe: The presence of 6 or more symptoms

Below are the measuring criteria.

In the past year:

·         Have you had times when you drank more or longer than you intended?

·         More than once wanted to cut down or stop drinking, or tried to, but couldn’t?

·         Spend a lot of time drinking? Or being sick or getting over the aftereffects?

·         Wanted a drink so badly you couldn’t think of anything else?

·         Found that drinking – or being sick from drinking-often interfered with taking care of your home or family? Caused job troubles? Or school problems?

·         Continued to drink even though it was causing problems with family or friends?

·         Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

·         More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

·         Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having a memory blackout?

·         Have you had to drink much more than you once did to get the effect you want? Or did you find that your usual number of drinks had much less effect than before?

·         Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

What score did you get after answering the questions honestly?

The equivalent term for “alcoholism” in the DSM-V is “Severe Alcohol Use Disorder”. In people with a severe alcohol use disorder, the body and brain have become dependent on alcohol for normal functioning.  This is also known as “addiction”. The American Society of Addiction Medicine defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences”. (Please note it is treatable!)

It’s important to note that the support group Alcoholics Anonymous (AA) use the term “alcoholic” for a few reasons. First, when Alcoholics Anonymous was formed in 1935 the study of addiction was still young. We didn’t know what we do now about stages of use and how the brain is affected.

Also, in AA each member decides on their own if they have a drinking problem. “The only requirement for membership is a desire to quit drinking” (Big Book of Alcoholics Anonymous). Notice that it does not state “You must score 6 or higher on the DSM criteria”. All members do have to identify as an alcoholic, but the group does not require a specific definition of “Alcoholic”.

The purpose of the Big Book of Alcoholics Anonymous was to “raise the bottom” so people wouldn’t have to hit the low bottoms that the founders of AA. So, in DSM terms, AA hoped to bring people in when they were still in the mild or moderate classifications. They have been successful in doing just that.

People with severe alcohol use disorder usually cannot go without alcohol for more than a few hours without starting to show signs of alcohol withdrawal. The first of these symptoms are tremors/shakes, rapid heartbeat, hypertension, heavy sweating, loss of appetite, and insomnia. As withdrawal continues symptoms get more severe (seizures and delirium tremens) and potentially deadly.  For this reason, people with a severe alcohol use disorder need to be monitored by a physician during withdrawal. Support systems like substance abuse counselors, recovery coaches, and support groups should also be utilized.

In conclusion, the question to ask yourself shouldn’t necessarily be “Am I an Alcoholic?”. It should be what stage is my drinking and do I want to continue to live (or die) with the consequences?” Chances are, if you are reflecting on this question, you want your life to be different.