Everyone has a viewpoint on what alcoholism is and what should be done for it. To learn about it we need to take out of our heads what we think we know already.
Otherwise we may be stuck with attitudes formulated as a result of distressing events in our families or with friends or at work. That bias is not good science.
Alcoholism is a misnomer: it names the illness after one of its treatments (comparable to calling sore throat penicillinism).
Alcohol ‘treats’ the sense of inner emptiness with which some people are born. Cannabis, cocaine, heroin, nicotine, caffeine, sugar, Diazepam, Prozac and many other mood-altering substances do the same. Thus, to understand this inner emptiness, we have to look at its effect on all addictive tendencies – not just on alcohol consumption.
The sense of inner emptiness an alcoholic feels may be due to a genetically inherited defect in the mood centres of the brain. Anything that satisfies it will become a friend – because it works in lifting the mood. Stopping using it will restore the inner sense of emptiness. As time progresses, the dose needs to be increased in order to achieve the same perceived beneficial effect. Eventually alcohol withdrawal symptoms occur and sometimes these can be dangerous, such as epileptic seizures. Giving up alcohol is therefore challenging both psychologically and physically.
The diagnosis of alcoholism is beset with difficulties because the condition is commonly seen as a weakness of will or as a stupidity or depravity. These often fly in the face of the evidence from other aspects of the individual’s life. Physical examination and blood tests can be very helpful but the patient may still deny the significance of the evidence in front of his or her eyes and point to many acquaintances who are in a much worse state. This ‘denial’ is the basic psychopathology of any addiction. We hang on to various ‘not yet’s in a rearguard action that is designed to reassure ourselves as well as other people that we are not really alcoholics: heavy drinkers maybe, but definitely not alcoholics.
The most accurate assessments are on addiction questionnaires. This enables us to differentiate people who are being silly from those who have an addictive tendency. It separates the partygoers from the alcoholics in a way that looks at why people drink rather than at what they drink or when or where or how much (none of which makes that distinction).
Assessing the progressive damaging consequences of alcoholism also enable accurate diagnosis, hopefully before the individual is comatose. Thus, we may not see the elephant (alcoholism) but we can see where it has been and we can deduce that only an elephant could have caused that level of widespread damage.
It is only when the painful damaging consequences of our drinking, and other addictive use, become more distressing than our perception of giving up these close friends that we become able to consider doing so.