There may not be a good definition of alcoholism per se, but there is a functional definition of addiction - namely the continuing use of a substance or a practice in the face of adverse consequences. There will never be a formula for determining how many drinks one has to have per day/per week in order to be an alcoholic, since it varies too much according to the individual pathology.
As is somewhat explored in Dr. Drew Pinsky’s book “Cracked” , the problem with AA and any other program is that they cannot make someone “get it,” i.e. understand that their behavior is self-destructive, has profoundly hurt people in their lives, and will utlimately lead to their death. Sometimes it is because their addictions were spurred as a way of dealing with feelings from an abusive childhood. Sometimes it is because they are with someone or associate with people who have similar addictions and perpetuate the behavior. The very “reward” chemcials that the addiction process stimulates in the brain, however, makes it very difficult for people to make rational decisions. Even when an addict quits their drug of choice, however, the “reward” chemical process in their brain isn’t similarly cut off. That’s what programs like AA are for - to manage not just the initial reactions of an addict but also to help manage their long-term coping strategies for life without their drug. While it may be stereotypical for AAers to all be chain smoking, this sort of coping behavior is probably preferable to the other behaviors especially linked to addiction, gambling and random sex.
And this difficulty in getting a handle on what does or does not constitute alcoholism is what disgusts me about non-problem drinkers being so insistant that problem drinkers ought to try a little harder to drink in moderation. Drinking alcohol is in no way essential to the good life but it can sure contribute to the bad life.
Time for some actual evidence-based research on treatments for alcoholism, folks.
In 2002, the Project Match study released its results of the largest clinical trial ever comparing treatment results. It was widely hailed as the first such study to objectively assess outcomes. It compared Twelve-Step Facilitation therapy, Motivational Enhancement therapy, and Cognitive-Behavioral Skills training. And it concluded:
Patients who had high levels of anger management problems did better with Motivational Enhancement therapy.
Patients whose alcohol dependence was assesed to be low did better with Cognitive Behavior therapy.
But patients whose social structures revolved around drinking, patients who had a high level of alcohol dependence, and patients with minimal psychopathology all did significantly better with 12 Step therapy. And frankly, these 3 types of “problem drinkers” make up the largest segment of the treatment candidates.
AA is not for everyone. And I say that as a fuzzy Deist/Agnostic alcoholic physician and AA member with over 15 years of sobriety whose own patient population has about a 70% substance abuse rate.
But we now have decent objective evidence that for certain very common types of problem drinkers, The 12 Step success rate is higher than the two other most commonly used treatment modalities.
And let’s not beat up on AA for the push in certain segments of society to make a lot of problem drinking into full-blown alcoholism. That was more a phenomenon of treatment centers and even judicial systems, who mandated that their patients/convicts must go to AA. As an AA member myself, I hate to see the unwilling being shoved into our meetings when they themselves don’t want to be there.
AA’s growth was based on attraction rather than promotion, and the ideal AA attitude has always been; “Think you have a drinking problem? Here’s what our drinking problem was like. Here’s what we did to help ourselves. If you think you’re like us and want to do what we did to get better, you’re welcome to join us”.
Most of the test is based very much in the present (Do you do these things now?), not what one has done over one’s lifetime. And you have to answer positive to 4 of 12 fairly heavy duty questions about your drinking for AA to say that you probably have a problem with alcohol. Then AA concludes that only you can decide if AA is right for you.
Again: Yes there is credible scientific evidence that 12 step programs do work better for many alcohol abusers.
The ONLY requirement for AA is a[I] desire to stop drinking*.
That is it. Period. If you drink after going to AA and want to try to stop drinking again, you are welcomed back with open arms.
What’s with everyone trying to change the fact pattern of the OP???
The alcoholic in my scenario DOES NOT see a protocol minister before the ceremony to discuss his/her aversion to alcohol.
NO, Prince Charles does not have a sippy box of Mott’s Apple Juice in his suit coat for the possiblity that the person given the wine is an alcoholic.
The purpose of the hypothetical is to gauge what people would do in a very awkward and high pressure situation.
If you can’t get your mind behind the queen thing, what would you do if the Pope gave you a chalice of wine that is now the blood of christ during a private mass with him and the College of Cardinals and you are a devout Catholic?
Sorry. That actually resolves the dilemma.
A Catholic who did not choose to receive Communion from the cup would simply shake their head and not accept it and it would be considered the height of rudeness for anyone, including the pope or his most officious undersecretary, to ask “Why?”.
You’re back to the Queen, I’m afraid. (Although I suspect that a polite declining to take the cup would be appropriate under any circumstances.)
I’m of the belief that an alcoholic could take a deliberate, measured swig (for his country) without imploding. I don’t see it as falling off the wagon as long as self-control is maintained. We’re talking about a single event. If you change the parameters and make it a daily/weekly event then it wouldn’t be advisable.
I think folks do it because it’s so extraordinarily implausible; you may as well involve giant squids in it. You’ll note that plenty of us do answer it as written, no matter how implausible it is.
I do wonder why you go for the implausible. There are far more plausible scenarios. For example:
There’s a person you work with who you have a major crush on. At some point, she (or he) invites you out with the gang to a party. She disappears at the party, and shows up a minute later with two beers, handing one to you. You’re pretty sure that she’s a party girl, and if you turn the beer down, you turn down any chance of being with her.
Frankly, that’s a harder call, I’d think. I mean, who cares about offending the queen, compared to offending a major hottie who seems to like you?
To most people who are in a 12-step program, the first thing you have to accept is that you have no self-control over alcohol. Someone who is capable of exerting self-control over alcohol is by definition not an alcoholic.
You’re invited out for a private dinner with the CEO of your company just before a very big promotion is possible. When the waiter arrives, the boss orders two scotch and sodas, and waves one your way, drinking deeoply from the other. Do you drink? Do you tell him why not?
In general the act of ordering a drink represents a loss of self control. However, this was a very specific “what if”. I know a fair number of AA members who drink non-alcoholic beer (which has small amounts of alcohol). I’ve never had to wrestle a drink out of their hand. Self control is just that.
The question could be framed in a different manner: would taking a drink that you actively reject cause you to lose control? There is no such thing as no self-control, just a lesser degree of it. But to be clear, I’m not arguing against the level of temptation a drink causes an alcoholic.
It might not. But many alcoholics fall off the wagon that way-they figure, oh, a sip won’t hurt. And then, oh, if I can take a sip, I can have one drink, just one. You see where this is heading, right?
Most good recovering alcoholics believe that while they still have another good drunk left in them, they may not have another recovery left in them. We’d all probably survive the night just fine, but it might be long and long again before we were able to get sober.
If someone held a gun to my head, and said “drink alcohol or die”, I’d drink. But that would have to be the sort of threat level it would rise to for me to do that. I’d also figure I could probably remain in recovery, and indeed not consider it a relapse, since it was forced on me.
I know some devout catholic alcoholics who take communion wine regularly without trouble. But they tell me that it is because they truly do consider it a sacrament, not an alcoholic drink.
And I’ve taken potent IV narcotics while in recovery, for invasive (and painful) procedures and didn’t fall back into drugs or alcohol. But the medications were not controlled by me, they were for a purpose other than getting high, and I worked damned hard after it was over to get to my meetings and talk about it.
I also once took a sip of punch which I thought was non-alcoholic, but realized after one swallow that it wasn’t. I stopped there, and had no problems.
But alcohol and drugs did a real number on me. Over and over and over again. I do not ever want to go back there. So I don’t intend to ever take a sip to be polite, or to fit in, or to obey protocols.
I’ve no doubt. But what I was asking about was the numbers. How can they know that 14% of the US population is in AA if AA is anonymous? How do they count them and know they haven’t counted anyone twice or three times?
14% of the US population isn’t in AA. SaintCad probably meant that 14% of those who took AA met some definition of success.
In the US, of those age 12 & above, 120 million consumed alcohol last year. Of those, 17 million are classified as problem drinkers. You asked about recovering alcoholics, I would guess about 10-12 million, tops i.e. 5% of those 12 & above, but 5-6 million more conservatively.
Yes, and anyone who claims that people can learn to drink in moderation after having demonstrated an inablility to do so over a period of years needs a tremendous resumé. Years of studying alcoholics and alcoholism, published studies of work in the field in medical or other peer reviewed journals, and a solid and verifiable record of success with actual patients would be a start.
I doubt that the Queen would offer you wine without asking, but if she did, accept the glass or cup, but don’t drink from it and don’t explain why unless she asks – which she won’t.
OK, just to clear this up, is it implied that the guy in the story went on the have many, many more drinks over the next few days and ended up in a coma, or did the one glass do him in because it was a shock to his system from being clean for a few months?