What is alcoholism?

Alcohol Health & Research World, Fall, 1991 by Daniel K. Flavin, Robert M. Morse

(2) The National Council on Alcoholism is now known as the National Council on Alcoholism and Drug Dependence.

(3) The American Medical Society on Alcoholism is now known as the American Society of Addiction Medicine.

(4) Alcohol-related disabilities refer to physical, mental, and social dysfunctions in which alcohol use is implicated.

(5) In this study, problem drinkers were identified as those whose alcohol consumption averaged more than 8 oz of hard liquor per day and who reported either concern over their control of drinking or others' concern over their alcohol abuse, or both (Vaillant 1980). vides the foundation for the evolving emphasis on treatment matching (discussed in greater detail below) and expansion of treatment services available to the alcoholic.

Progression

Once considered invariably progressive, the revised definition of alcoholism intentionally uses the term "often progressive" to underscore that some plasticity in drinking patterns exists, even at the heavy-drinking end of the spectrum of alcoholic behaviors (Vaillant 1983). While many alcoholics experience an inexorable progression of physical, emotional, and social consequences, even death, others may spontaneously abstain or reduce their alcohol use. Such plasticity argues for flexibility in treatment concepts.

Impaired Control

Confusion exists with regard to the concepts of loss of control versus impaired control. Some of this confusion comes from the acceptance as fact that loss of control over drinking can occur with one drink (for example, as exemplified by the one drink, one drunk maxim of Alcoholics Anonymous). In addition, confusion arises from an emphasis on observation of drinking events over a limited, rather than a long-term, period of time. The concept of impaired control was chosen for the definition of alcoholism as being more applicable to the understanding of alcoholic behavior than is that of loss of control, because impaired control implies that observations are made over a longer period of time.

For example, many alcoholics are able to control their drinking in certain situations--for example, an alcoholic may drink only one glass of champagne at a wedding, seeming to drink under control. But later the same day or even the next week the alcoholic may drink uncontrollably. Thus the alcoholic's drinking behavior, viewed only at the time of the wedding, might lead to the speculation that this behavior is controlled by "will power." When the alcoholic's behavior is considered over a longer period of time, the meaning of impaired control--and the involuntary nature of addiction--becomes apparent.

Preoccupation with Alcohol Use

Preoccupation with alcohol use has long been noted as a clinical sign and symptom in the alcoholic; three of the seven characteristics of the alcohol dependence syndrome (narrowing of the drinking repertoire, salience of drink-seeking behavior, and subjective awareness of a compulsion to drink) cite preoccupation with or compulsive use of alcohol. Alcohol's reinforcing power[6] is formidable; recent research dealing with cellular and biochemical effects of acute and chronic alcohol use indicates a potential biological basis for this reinforcement in many alcoholics (National Institute on Alcohol Abuse and Alcoholism 1990). Thus, preoccupation with alcohol use has become a target for both behavioral and physiologic interventions in treatment, especially with those interventions that address craving for alcohol and the prevention of relapse (National Institute on Alcohol Abuse and Alcoholism 1989).