Alcohol Use Disorder and our refusal to accept the spectrum of addiction

Last night I saw on Instagram that The Ellen Show made a video interviewing children about their mother’s drinking habits. There are many cues to problem drinking in this clip that are not only ignored but glorified. To make matters worse, Popsugar posted the video clip with a caption: Kristen Bell Asks Kids If Their Moms Like Wine, and Oooooh, Boy, We Need a Drink”. Based on people’s reactions to the video, it indicates that women all over the U.S. are actually relating to the idea that they need to drink wine in order to deal with their children, are “not waking up” after drinking, and they are hungover often enough for their children to notice. You can watch the video here.

I could go off on a rant right now about how fucked up the acceptance and depth of denial is in our culture regarding alcohol addiction (especially among mother’s & “their much-deserved wine”). It has been proposed and widely accepted in science that alcohol addiction is actually a spectrum, meaning that all drinkers lie somewhere along this spectrum, and the hope is to never cross the threshold into full-blown addict status. I’ll save how I feel about this way of thinking for another post, but please keep that in mind as you read this and start to examine your own drinking and that of those around you.  What I do want to do today is demonstrate how common problem drinking is by describing many of the observations I’ve collected over the last two years, on and off in sobriety.

Here is some information from the National Institute on Alcohol Abuse and Alcoholism (you can read it in its entirety here). I’m going to break down, question by question, why I think that the method of reporting the answers to these questions (since people answer the questions THEMSELVES) to determine problem drinking, is not only inaccurate but very problematic.

From my understanding, the majority of people are responding to a random survey conducted, which means they perform a self-assessment on their drinking. This poses a problem, obviously, because it is very easy to downplay and justify your drinking when asked to share it publically. For fuck’s sake, I wasn’t even honest with my doctor when I was drinking “normally”, much less once I had a problem. I’m going to go through these questions and comment from the perspective of close friends of mine, who don’t have a drinking problem according to the criteria set forth.  Italics are the article, bold is my writing.

To be diagnosed with AUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD. The severity of AUD—mild, moderate, or severe—is based on the number of criteria met.

To assess whether you or loved one may have AUD, here are some questions to ask.  In the past year, have you:

  • Had times when you ended up drinking more, or longer than you intended? Almost everyone I know has done this in the past year, likely every weekend. Every time I join at the bar, there is at least one person who says they should go home by 11 and stays out till 2AM instead. It’s usually about half the group. People rationalize this by telling themselves “drinking more or longer than they intended” would mean a bender, right?! Like two or three days, not two or three hours!
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t? Again, many friends have stated that they should “cut back” on their drinking in the past year, and almost all (I actually can’t think of anyone who succeeded) who have stated this, tried to give it up for 2 weeks or a month, without being able to complete the time period without drinking. This is a very important anecdote. This happens all the time, yet we seem to be missing this cue. Two weeks is not a very long time. Perhaps it is because all drinkers are on a spectrum of addiction…hmmm…
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects? This is a mostly private question, so it’s hard for me to know, but it’s rare that I don’t notice a person, the day after drinking, complaining of a headache, feeling ill, or being tired. 
  • Experienced craving — a strong need, or urge, to drink? Does, “I’m so stressed I need a drink!” count, because I hear that (at least) weekly. 
  • Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems? This one is a little rarer, but I do often witness tardiness, irrational decisions at work, and apathy from my friends who drink often. 
  • Continued to drink even though it was causing trouble with your family or friends? Almost everyone I know who has been told that their drinking is problematic has ignored their friend’s or family’s concerns until it was much more serious. Most arguments, disagreements, miscommunication, and even fights between couples and friends would be eliminated without alcohol. 
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink? People do this all the time. An example happened just this past weekend: I had plans with a close friend on a Friday evening, and the day-of they told me that they were stressed and needed to drink after work and asked if I “would like to watch them pound margaritas”, I said no, and they ditched me for booze. This happens to me a lot. I also used to do this, a lot.
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)? Every time I go out to bars or otherwise I have to convince at least one friend not to drive home and let me give them a ride. 
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?  I hate this question. The issue I take with this is that people don’t realize how deep the connection is between alcohol and anxiety. They also don’t realize that alcohol is a toxic poison, wrecking havoc on your organs, immune system, and brain. If you have anxiety and/or depression, you shouldn’t drink. It makes it worse, plain and simple. It rewires your brain! It could even be the root cause. And “adding to another health problem”? Are you kidding, it is the cause of so many health problems. So, yes, most people I know continue to drink even though it makes them feel depressed or anxious or is adding to another health problem. 
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before? Jesus Christ. Let’s just compare how drunk we all got the first time we drank with how much we need now to achieve that same effect. How is this even a question on here? “Tolerance” steadily increases the longer you drink, this is a known fact. 
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there? This is called a hangover. It’s often made into a joke and is usually “cured” with mimosas, Xanax, or a combination of the two. 

My point is that when we are self-diagnosing a problem, we can justify our answers. I started Googling if I had a drinking problem years before I admitted it to myself. I found ways to answer the questions to fit what I wanted to believe: that of course I wasn’t addicted to alcohol.

My hope is that one day we see the dangers of alcohol and treat it like we treat cigarettes, heroin, cocaine. While addiction still happens and unfortunately so do the tragedies associated with those drugs, at least we are well aware and educated on how bad they really are for you. Had I been told growing up that alcohol would someday derail my life from age 26-30, kill my boyfriend’s mother, and hold many of my friends as prisoners from living the life they deserve, I never would’ve taken a sip. Instead, I was surrounded by it, taught to think it was cool, and most importantly, thought that if my body couldn’t handle it, there was something wrong with me. Shouldn’t it be the other way around? Shouldn’t we teach our children that numbing ourselves and evading life should be avoided? Shouldn’t we be educated that alcohol is toxic and poisonous and it kills more people every year than all other drugs combined?

I was told as a kid to stay away from heroin because it is addictive and could kill me. I was never told that alcohol is classified as the most dangerous drug on the market when you consider harm to user and harm to others (as shown here). This is horrifying considering it is so widely accepted and celebrated in our society.

I’ve been sober on and off for two years, and if I’ve learned anything from constantly observing, listening, and supporting my friends, it’s that alcohol addiction is a spectrum that the vast majority of drinkers are somewhere on, and it is a very slippery slope. I wonder when we are going to wake up and start taking the spectrum of alcohol addiction seriously and stop this cultural encouragement to continue to deny an extreme public health issue.



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