I’m interested in how Alcoholism is defined within professional circles and how this interpretation filters down into society to the individual. Is it a mental disorder, a spiritual malady, a disease, a choice, a combination, and how is it diagnosed and treated? Following is what I learned and it isn’t necessarily what I was expecting. Please leave some feedback, I’d really like to start a discussion regarding your experiences as individuals trying to embrace meaningful long term recovery.
The Diagnostic & Statistical Manual of Mental Disorders (DSM) IV was published in 1994 by the Americam Psychiatric Association (APA); it took 14 years of contentious revision for the DSM V to be published in 2013. Alcohol Abuse and Alcohol Dependence diagnoses from the DSM IV were combined to introduce Alcohol Use Disorder (AUD) with sub-categories of mild, moderate & severe. ‘Legal problems’ was removed as criteria for meeting a positive DSM IV diagnosis of Alcohol Abuse/Dependence. ‘Cravings’ was added to the considered DSM V criteria when diagnosing cases of AUD.
Obviously these changes have had an impact on how people are perceived by their peers, health care professionals, private businesses i.e. insurance companies, landlord’s and the State i.e. welfare/universal credit eligibility. The DSM IV defined Alcohol Abuse as meeting one + out of four possible criteria, and Alcohol Dependence as meeting three + of seven criteria within a year. The DSM V similarly has eleven criteria, however only two have to be met within a twelve month period to diagnose AUD within three severity levels.
The International Classification of Diseases (ICD) was last published in 2019 (ICD 11). It’s used by the WHO and professionals globally. ICD11 isn’t used as widely by psychiatrists as the DSM V is more thorough and exact. For example, ICD11 looks at behavioural symptoms of AUD as apposed to leaning towards neurobiological processes as the DSM V does.
A hopeful development that remains elusive to date is the connection between societal tendencies and cognitive function in relation to AUD. Both the ICD11 and DSM V mention the social dimension, however modelling the processes has proven difficult to define. Could a breakthrough in this area of neuroscience pave the way for effective anti-addiction medication?
Existing medications include:
- Disulfiram causes unpleasant symptoms such as nausea and skin flushing whenever you drink alcohol. Knowing that drinking will cause these unpleasant effects may help you stay away from alcohol.
- Naltrexone blocks the receptors in your brain that make you feel good when you drink alcohol. It can also reduce your craving for alcohol. This can help you cut back on your drinking.
- Acamprosate helps you avoid alcohol after you have quit drinking. It works on multiple brain systems to reduce your cravings, especially just after you have quit drinking.
I’ve always disliked the Medical Model’s definition of abnormality needing to be fixed, cured or prevented. The emotional and spiritual elements seem to be neglected for a preference to scientifically solve the physical, psychological and social dilemmas. Of course they’re all linked as the combined elements that make us human beings but my recovery required something that nourished each aspect of our human experience.
My personal experience of navigating through episodes of prolonged drinking, binges that developed into dependence, home detox and relapse have been documented by various medical institutions. The GP that advised I avoid AA meetings as I could potentially be exposed to people in various states of inebriation and I was doing so well being sober for three months. I sensed another drinking binge about to happen and visited my family doctor for some kind of support. On this occasion white knuckling tragically turned into another inevitable relapse.
I was an out-patient at the local hospital that used shock tactics such as explaining the consequences of when esophageal varices rupture and liver cirrhosis to warn attendees. I found it amusing that they condoned and actively encouraged ‘controlled drinking’ after a prolonged period of sobriety. At the time I instinctively knew that once I had began to drink there was no guarantee when I was going to stop; either when the money ran out, or when I was in a hospital bed, a cell or I had come full circle to drink myself sober and experience the moment of clarity where sobriety is the answer.
We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve. A.A. pg. xxviii
The above excerpt was included in the foreword of the Big Book of Alcoholics Anonymous, 1947. The DSM didn’t include ‘cravings’ in its definition of alcohol abuse / dependence until the the most recently revised edition 2013. Until we have a holistic approach to addiction recovery where people can learn what recovery means to them and what tools are available to them (detox, supported accommodation, AA, peer group support, CBT, SMART, AVRT etc), we will continue to suffer on a personal, societal, national, global and spiritual scale.
Since I last drank, 17th March 2017, I have pursued sobriety longevity and learned that recovery is achievable on a daily basis through abstinence supported by Fellowship. The Big Book states “We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.” p85. My spiritual condition is revived, maintained and conditioned by unity, recovery and service against a physical, mental and spiritual disease.
The opposing methods of how to treat alcoholism tend to merge at the crossroad of social gathering. Whether it’s described as the ‘pathology of social cognition’ or quite simply ‘fellowship’, the key to stopping the advancement of the disease is through engagement, presence, belonging.
Brené Brown’s definition of spirituality emerged from data decoded in 2009. I was in awe of her discoveries as a statistician because numbers don’t lie or coerce in ways people can. ““Spirituality is recognizing and celebrating that we are all inextricably connected to each other by a power greater than all of us, and that our connection to that power and to one another is grounded in love and compassion. Practicing spirituality brings a sense of perspective, meaning, and purpose to our lives.”