Does alcohol abuse equate to alcohol dependence?

October 12, 2004 2:50 PM

From the brand new AxMe Anonymizer

"Is my friend an alcoholic?" [MI]

"He only drinks maybe four times a year, but when he does, he gets REALLY REALLY drunk, does (and says)horrible things, blacks out, etc. He's incredibly touchy when it comes to talking about it. Immediately goes into denial, gets defensive, etc. (When he's not drunk, he's a sweetheart.)

Because when he DOES drink, he acts like an alcoholic, many people (who meet him for the first time when he's on one of these benders) assume that he *is* an alcoholic.

If it makes any difference, he's not a college student. He's in his 40s.

But can one really be an alcoholic when one drinks so infrequently? Don't alcoholics drink all the time?

Is "alcoholic" a fuzzy term, or is there a clear medical definition. Can a brain scan be done that determines whether or not someone is an alcoholic, or is it purely about behavior?"

(once again, this is not my [LimePi's] question, but a question from an anonymous MeFite)

posted by LimePi to health (18 comments total)

An alcoholic is someone addicted to alcohol. Your friend, if he drinks a few times a year and isn't constantly craving/needing alcohol, is not.

What your friend is, apparently, is simply an asshole when drunk. That's got nothing to do with alcoholism.
posted by majick at 3:00 PM on October 12, 2004

This sounds largely like a labelling issue. Call it whatever you want to call it. You describe the situation in detail, including the problems that come with it. What more do we hope to gain by finding the right label to apply to this?

I generally associate "alcoholism" with one of two things:

1) Excessively frequent drinking
2) Inability to choose when to drink and when not to

Sounds like #1 doesn't apply. I can't tell about #2. It generally means stuff like: "drinks even though he knows he has to drive home," or "drinks anytime anyone offers him one." That kind of thing.

Your friend might just be a bad drinker. Sounds like he has no tolerance, and doesn't know his limits. That's not the same as addicition
posted by scarabic at 3:00 PM on October 12, 2004

Here's my rule of thumb: if people are scared to be around you when you are drinking, and you drink to the point where you are scary anyway, it doesn't matter how often you do it: that you do it is enough to tell me you are an alcoholic.

There are functional alcoholics, the kind of people who get by in a minor cheerful haze so that they work and live in a kind of mirage, and no one knows they have a problem except for the poor suckers who love them. And then there are those like your friend, who let the pressures of the weeks and months go by until they are sufficiently wound up enough to justify their binging.

If your friend dies while drinking this way, he'll be no less dead than the guy on the park bench with a bottle of Jack frozen to his hand.

So, I am sorry to say, in my books your friend is an alcoholic, and his reluctance to deal with it is life-threatening, and he is bringing danger on his head and all who must endure him in these periods.

It is a sad and scary thing and I wish you, anonymous, the best of luck in dealing with it.
posted by melissa may at 3:13 PM on October 12, 2004

Sounds like he's got The Thirst. It doesn't sound like your friend needs treatment or support for alcohol abuse.

If your friend were to become a regular drinker, and this behavior did not change, pronto, then there's cause for alarm. Bottomless sponges I have known who exhibit the inability to cease consuming alchohol after a few have gone on to legendary and demonic struggles with The Thirst.

But of course, this is all really more your friend's business than anyone else's.
posted by mwhybark at 3:14 PM on October 12, 2004

There's a lot of charge around the word "alcoholic," and a lot of energy often goes into figuring out whether a person is or isn't. This is partly because the term is both a "sort of" diagnosis and a stigmatized identify all in one.

The diagnostic criteria such as ongoing desire to drink in spite of bad things happening, the need for higher amounts to achieve the same effect, withdrawal, etc. are for conditions in the Diagnostic and Statistical Manual of Alcohol Abuse and Alcohol Dependence, not "alcoholism."

For the diagnostic end of things, there are standardized tests such as the CAGE which purport to indicate whether someone is or isn't.

I find such tests useful at times, but ultimately unsatisfying, because there's not much action to be had until a person themselves comes to believe that they have a problem with alcohol. In my view, if someone's blacking out, fighting, having DUIs, whatever, I certainly think there's evidence to say that he has a problem with alcohol.

But is he an alcoholic? This is what lots of people want to know, and usually they think that they *aren't* alcoholics because xyz. And xyz in this case are things like, "An alcoholic drinks every day," or "An alcoholic doesn't hold down a job," or "An alcoholic is homeless and filthy and disgusting..." or whatever. Go to any AA meeting, just to watch, and you'll find out that alcoholics come in all different shapes and sizes. Or better still, if your friend goes to a Alanon meeting, he or she will find out how to think about the meaning of that question for his or her own life.

I usually ask people what difference it would make if they thought they were or weren't alcoholic. I like to open the question because figuring out the answer is a process of someone coming to know him or herself.
posted by jasper411 at 3:27 PM on October 12, 2004

According to the National Institute on Alcohol Abuse and Alcoholism, your friend is not an alcoholic. It sounds like he has a binge drinking problem--which can be a path to alcoholism.

The connections between brain structure and behavior are, for many behaviors, tentative at best. A bit of poking around on PubMedcame out with some interesting studies on people who are potentially "at risk" for alcoholism, using ketamine and functional MRI. But, these studies slect their test subjects based on the heavily researched discovery that alcoholism is highly heritable. Sticking your buddy into a tube and zapping his head probably isn't going to give you a whole lot of answers, if any.

Not everyone who is an alcoholic has "alcoholic genes", and not everyone who has "alcoholic genes" is an alcoholic. I'd keep an eye on my friend, but overreacting and calling him a drug addict is not going to be a good way to gain his trust.
posted by LimePi at 3:29 PM on October 12, 2004

The answer is in the question - He only drinks maybe four times a year, but when he does, he gets REALLY REALLY drunk, does (and says)horrible things, blacks out, etc.
He seems to know this and is why - He only drinks maybe four times a year. You don't have to be drunk to know you have a drinking problem. When you can’t control your self it is the sign.
posted by thomcatspike at 3:29 PM on October 12, 2004

I agree with thomcatspike, and I don't think there's more I can add. If he's rolling out of bed and taking a shot to "wake up", then he's alcoholic. Right now he's just a bad drinker. I know people like it, we all do. Some have a harder time controlling themselves under the influence of anything. And if he was younger I'd say have a sit down and knock some sense into him. You say he's 40 and sensitive about it... let sleeping dogs lie. Just make sure it doesn't get worse.
posted by geoff. at 4:14 PM on October 12, 2004

Your friend knows the answer already.

If he worries that he is drinking too much, the answer is yes. Normal people don't ask themselves this question.
posted by cedar at 4:15 PM on October 12, 2004

I have to say I disagree with a lot of what's been said. I think are different types of alcoholics.

Some, like your friend, can't control themselves when drinking. Yes, it is binge drinking, but if he can't stop (or control themselves) once he starts, then I think he has a problem.

I had a boyfriend like this once, and my therapist pointed out that he sounded like an alcoholic. But I had a different version of one in my mind so I denied it. But I slowly realized that there's not one kind (esp. after going to ACOA - Adult Children of Alcoholics - meetings).

So call him an alcoholic or not, he has a probelm.
posted by evening at 5:40 PM on October 12, 2004

He has a problem (alcohol abuse) that:
1) he can't control (he can control when - at least somewhat - but he can't control how much), and
2) is damaging his relationships (does he honestly think he can play Jekyll and Hyde four times a year and still get a pass on his behavior?)

He doesn't have to drink all the time to have alcohol make him and his friends miserable, but the red flag is that every time he drinks it turns out bad and he continues to drink. That sounds like a guy who really ought to stop drinking. There are people (ahem) who can help him with that.
posted by stefanie at 5:57 PM on October 12, 2004

stefanie, I really don't think sending this guy to AA, or pressuring him into attending AA meetings, is the right thing to do. I believe 12-step programs can work (a relative of mine is in OA, and I hope that eventually he can get a hold of his lifelong problem... but that's another thread), but I really don't think that occasional binge drinking, even occasional problem binge drinking is reason enough to make one of your friends sit in a metal folding chair daily. For 90 days.
posted by LimePi at 6:18 PM on October 12, 2004

It's a fuzzy term. My own working definition is 'Is alcohol negatively impacting this person's life?'

If the answer's yes, then I say they've got an alcohol problem.

What to do from there is a problem - adults are big boys and girls, you can't just give them a time-out from the alcohol sandbox - so you have to tailor the response to the situation.

In this situation, if the alcohol-troubled person doesn't want to discuss it with the concerned party, there may not be much to do, except possibly if appropriate bring it up with his loved ones.
posted by ikkyu2 at 7:30 PM on October 12, 2004

To say that the friend does/says "horrible things" is incredibly vague. For starters, are these things illegal? Do his words or actions place him or others around him in immediate risk of physical harm?
posted by juv3nal at 10:31 PM on October 12, 2004

I'm no huge fan of AA (and I know that trying to force people to go is utterly useless), but I'm not a fan of having people get outrageously drunk and turn mean, either. If someone's drinking is affecting your life (and I think in this case it is) then you've got to tell him, even if that means suggesting he do something as loathsome as sit on a folding chair in a room full of sober people. Otherwise you say nothing while he continues to get nasty drunk several times a year. That'll be fun.
posted by stefanie at 12:10 AM on October 13, 2004

May be helpful:

Alcoholism and Problem Drinking.
posted by monkey closet at 1:17 AM on October 13, 2004

Melissa May: Here's my rule of thumb: if people are scared to be around you when you are drinking, and you drink to the point where you are scary anyway, it doesn't matter how often you do it: that you do it is enough to tell me you are an alcoholic.

Huh? So Melissa, someone who drinks 2 bottles of wine a day while holding a job down and keeping up appearances (certainly not "scary") is not an alcoholic if we use your "rule of thumb".

Alcoholism is a psychological/physical addiction to alcohol. It is not in itself a particular symptom of alcoholism which many (I'd venture) alcoholics don't even display (i.e. being "scary").

Let's look at the dictionary definition first:-

al·co·hol·ism (lk-hô-lzm)
n.

1. The compulsive consumption of and psychophysiological dependence on alcoholic beverages.
2. A chronic, progressive pathological condition, mainly affecting the nervous and digestive systems, caused by the excessive and habitual consumption of alcohol. Also called chronic alcoholism.
3. Temporary mental disturbance and muscular incoordination caused by excessive consumption of alcohol. Also called acute alcoholism.

Nowhere does it say someone has to be "scary". Many alcoholics aren't scary, but they are alcoholics nonetheless. Sorry to pick on you in particular here, but it's more your lazy opinion on this.....your post was just plain daft.
posted by SpaceCadet at 5:37 AM on October 13, 2004

I read your comment quite late, SpaceCadet, so I am sure you are no longer listening, but just in case: read the original post. If you fail to regard saying and doing terrible things, much less blacking out as scary, then you have no right to accuse anyone else of "daftness."

I can only imagine what the terrible things that the poster alludes to are. From my own experience with the great guy who goes on the unpredictable bender, I'll guess:

*spending white-knuckled hours at the bar or the party when you're dying to go home because you know he might kill himself if you're not there
*steering him out of fights
*steering others away who rightfully want to punch his lights out
*carrying him to your car
*cleaning up his vomit or waste
*struggling to turn him over so he doesn't choke on additional vomit
*covering bruises the next day from where he pushed you away when you were trying to save his sorry ass
*trying to talk to him about it later, then cowering from his rage
*waiting in fear every time you are in a situation where alcohol is present since you never know when he'll do it again

and, unless her friend actually deals with this

*regretfully giving him up as a friend because the "great" part of your friendship can no longer balance out all the fear

None of that is in the dictionary either, SpaceCadet. So maybe you should learn to think outside of one.
posted by melissa may at 6:48 PM on October 22, 2004