For those reading who feel they may a problem with alcoholism I will attempt to help you self diagnose.

I personally came into recovery via AA after my local doctor/GP, stated quite unequivocally that he thought I was an alcoholic. I was with my wife at the time.  The scales fell from our respective eyes.

Oh that’s it!? It wasn’t my troubled childhood, the premature death of my parents, my various difficulties with anxiety, depression, panic attacks, etc etc. It was because I was an alcoholic!

I have no doubt that the above factors contributed to the severity of my alcoholism but the other psychiatric issues I now consider to have been substance induced disorders which have either dissipated in recovery or have been treated in some way by a 12 step recovery?

Regardless of GP’s diagnosis of alcoholism I still need to self diagnosis.  I could not recover from alcoholism based on someone else’s diagnosis, however helpful. I had to identify myself as an alcoholic. Acceptance of this condition was the first step in recovery for me and countless others.

In the early days acceptance is based on acceptance of a destructive relationship with alcohol.

How do we define this relationship, this alcoholism?

There are various definitions of alcoholism mainly centring on  continued use of alcohol despite negative consequences. The Big Book of Alcoholics Anonymmous (1) simply states  “If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic.  “.

This useful useful article (2) discusses the “loss of control over drinking” concept, which academic studies have failed to prove or disprove in laboratory settings.

I believe this loss of control can occur spontaneously or over several drinking episodes. It is not an all or nothing phenomenon like the “allergy” concept of the Doctor’s Opinion in the Big Book. It is variable.

The return to uncontrolled drinking can take one drinking session for some or a number of drinking sessions for others.

“The loss-of-control phenomenon is the essence of any addiction and certainly of AD.

This refers to the inability of the AD person to predict with any degree of certainty how much he or she will imbibe from one drinking episode to the next.

Clinically, once the drinking episode starts, the AD person will be unable to stop in the middle of the episode without a very great struggle. Useful questions at interview include asking 1) whether patients feel compelled to continue drinking or find it very hard to stop drinking; 2) once they start, whether they find themselves drinking more than they wanted to or had planned to; and 3) whether they make rules to attempt to control their drinking through external means.

It is important to distinguish the loss-of-control phenomenon from craving. The former has to do with the inability to stop drinking once started.

The loss-of-control phenomenon occurs within a drinking episode. Forms of craving occur between drinking episodes. The loss-of-control phenomenon continues to be a scientific puzzle.

Despite ongoing research inquiry over many years, neuroscience has yet to define the CNS changes underlying the loss-of-control phenomenon that characterizes dependence.

Clinically, however, longitudinal studies of abstinence make it clear that once the control of drinking behavior departs, it does not return in most cases (3).

It cannot be relearned or reconstituted. In this sense, a diagnosis of dependence signals a permanent condition—including a permanent risk of uncontrolled drinking. “

 

 

1. Alcoholics Anonymous. (2001). Alcoholics Anonymous, 4th Edition. New York: A.A. World Services.
2. Beresford, T. P. (2007). What is addiction, what is alcoholism?. Liver Transplantation, 13(S2), S55-S58.
3. Vaillant GE. The Natural History of Alcoholism, Revisited. Cambridge, MA: Harvard University Press; 1995.