Defining Alcohol: What You Need to Know!!!

Today on the show we talked about Alcoholism.  We asked one of our guests Dr. David Reiss to give us more information about the disease.

Caveat:   I am not an “addictionologist” or a psychiatrist who works primarily in the area of addiction and substance abuse.  However, in over 25 years of experience as a psychiatrist, I can offer my opinions from a wide perspective, based upon the evaluation and treatment of well over 10,000 patients, many of whom were dealing with substance abuse issues personally or within their relationships and/or family.

“Alcoholism,” a term used ubiquitously within common language and lay discussion, actually does not have a specific clinical definition.  There is a non-precise definition for “alcohol abuse” – use of alcohol that is “excessive” to the point of causing problems; and there is a definitive definition for alcohol dependency/addiction – use of alcohol to the point that abstinence causes a physiological withdrawal syndrome (addiction) and/or psychological withdrawal syndrome (dependence).

The diagnosis of alcohol dependence or addiction is important for medical and psychological reasons:  if abstinence causes physiological withdrawal, which may range from discomfort to dangerous or even fatal medical complications (such as untreated delirium tremens); psychological withdrawal can lead to depression, anxiety, irritability etc.  Both encourage a return to alcohol use in order to end the withdrawal syndrome, and therefore, abstinence/recovery is more difficult in persons who are physiologically addicted or psychologically dependent.

However, apart from specific medical issues, in applying the term “substance abuser” or “alcoholic,” my over 25 years of clinical experience is completely consistent to what I was taught during my residency by renowned alcohol researcher and expert at U.C. San Diego Marc Shuckit, M.D:  it doesn’t matter how much or how little (volume) is consumed drink, or the frequency of use;  if the use of alcohol problems: medically, socially, legally, in personal/family relationships, etc. – then you have a substance abuse problem, you are an alcoholic. It is as simple as that.  

 If a half a beer once a week causes you to “go off” on your kid or significant other, drive in an impaired manner, become emotionally unstable, spend money irresponsibly, etc. – then you are alcoholic.  However, if you can have a few drinks per night with absolutely no negative impact medically (e.g., liver function), interpersonally or socially, C'est La Vie!

On the average, there are significant cultural differences in what is generally considered an “excessive” intake of alcohol.  Further, there is no doubt (supported by research) that in cultures where children are taught to drink responsibly from an early age, in general, there is less destructive alcoholism than in societies where alcohol abuse is encouraged, or where alcohol use is considered a taboo or a “rite of passage.”  Of course, that is a very general statement, and does not necessarily apply to any specific individual in any specific culture.

At a certain level of alcohol consumption (which will be different depending upon personal genetics and biological metabolism), no matter what the social circumstances, there may be destructive physiological effects (upon the brain, liver, carcinogenesis, etc.)  For example, drinking frequently to the point of gross intoxication, or “black out” – even if not leading to other psychosocial problems - will inevitably cause medical difficulties, injuring the brain and the liver.  Also, consumption of alcohol can interfere with the effectiveness of many different types of medications (and is dangerous in combination with certain medications) – alcohol most problematically and dangerously interacts with psychotropic medications (medications prescribed for psychiatric reasons) and psychoactive agents (anti-histamines, asthma medications that can be stimulating, pain medications, etc.), but may also interact negatively with other classes of medications.  It also must be recognized that despite the initial euphoric effect, alcohol is a chemical depressant that may contribute to or hasten the development of clinical depression in susceptible individuals even if not causing other overt problems.  However, low levels of consumption, without concomitant use of other drugs or psychoactive agents, if otherwise tolerated, may be medically “healthy” or even beneficial in some ways.

If the medically-dangerous/detrimental threshold is not met, the key to defining alcoholism is, very simply: “The presence of problems caused by alcohol consumption” – really a very easy concept to grasp.  However, especially in the United States, the prevalence of denial leads many people look for "objective measures” to define the problem/disorder, i.e., "If I'm not drinking ‘X’ amount; if I don't have withdrawal symptoms; if I haven’t received a DUI – then I can't be considered alcoholic."  If media, schools, etc. pick up on those “objective measurements” of volume and frequency of consumption (which are actually arbitrary), that can be destructive and can result in denial of problematic alcoholism (or less frequently, over-diagnosis of benign alcohol use).

Relying purely on a specific volume or frequency of consumption is not logical and is a clinically dangerous way of thinking of and conceptualizing alcoholism.  Conversely, in other cultures, if large volumes of consumption are considered “normal” and presumably not excessive, that leads to a different form of denial and under-identification of alcoholism.

Simply put, “If honestly, without invoking denial, you can definitively state that alcohol has no negative effect upon your health, life or relationships – then clinically, alcohol use is not a problem.  However, if any of those areas are negatively impacted by alcohol use, you are alcoholic and should seek some form of treatment or intervention, regardless of the volume or frequency of consumption – and any other conclusion is purely denial.

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Thanks Dr. Reiss!


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