Dec 11, 2018

Alcoholic v Alcoholism

My roommate and I could use help understanding the difference between alcohol abuse and alcoholism. Her older brother back in New Jersey is apparently struggling with drinking problems. This is according to her mom.


Nobody has confronted him yet because they’re worried about upsetting him. He’s never had a history of problematic behavior or anything. My roommate thinks it might be a new friend group at his university.


I suggested that we do some research to share with her family but we’re stuck trying to grasp the difference between an alcoholic and having alcoholism. Are they completely separate and what about the treatments?


This is a commonly misunderstood subject. The easiest way to begin understanding the difference is to consider both diagnoses two separate points along the same spectrum. The term “alcoholism” is, in fact, a non-clinical term used by laypersons. Medical practitioners and public health workers refer to it as alcohol use disorder (AUD), which consists of multiple stages of increasing severity and detriment. Within the context of AUD, substance abuse almost always precedes dependency.


It’s also wise to remember that this is a relatively widespread public health issue. In 2016, researchers at the National Institutes of Health (NIH) estimated that more than 50% of adults consumed alcohol in the last month and more than 25% of adults engaged in binge drinking in that same period. More importantly to your roommate is the fact that experts consider young adults at greater risk for this type of behavior. There is near consensus in the scientific community that much of this risk stems from cultural aspects seemingly ingrained in the American university ecosystem. In other words, peer pressure is the main contributing factor.


The stigma associated with having a “drinking problem” prevents many otherwise well-intentioned souls from disclosing the truth to friends and/or family. It’s probably safe to say that regardless of how the confrontation happens, her brother is likely to resort to denial and possibly even hostility. Those are natural reactions.


Another key consideration is whether or not there are factors aside from the alcohol abuse that require attention. Peer pressure linked to new friendships is a definite possibility, but that doesn’t make it the only one. There’s increasing evidence that many people who turn to substance abuse actually suffer from co-occurring mental disorders (e.g., anxiety, depression, schizophrenia, etc.). The medical establishment refers to the scenario as dual diagnosis. However, it doesn’t make sense to float the idea to her brother. Better to leave that topic to the professionals.


Next steps include reviewing the signs commonly associated with AUD to confirm whether or not a confrontation is necessary. Only the family can make that decision. You’ll want to be prepared with options in the worst-case scenario. There’s no shortage of alcoholism treatment centers in the region and despite what some would have you believe, many of the options are extremely affordable. Don’t anticipate any conversation to be simple. Your roommate should prepare for a strained relationship in the event that her brother has to face recovery. Optimism, patience, and compassion will be essential for the whole family.


“I avoid looking forward or backward, and try to keep looking upward.” — Charlotte Brontë

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