We Do Not Say “Alcoholic.” Here’s Why.

We Do Not Say “Alcoholic.” Here’s Why.

By April Wilson Smith, MPH, Lisa Chiodo, PhD, & Amanda Wilson, MD

At North-Star Care, we do not use the word “alcoholic.”  We do not believe that a person should be defined by a problem they struggle with.   

“Alcoholic” and “alcoholism” are not scientific or medical terms.  The Diagnostic and Statistical Manual (DSM) is the catalog of psychiatric diagnoses used by psychiatrists, psychologists, and the healthcare system to classify conditions for which people should receive treatment.  “Alcoholism” has not been in the DSM since 1980!  It was first replaced by Alcohol Abuse and Alcohol Dependence, then in 2013, the term Alcohol Use Disorder (AUD) was adopted.  Alcohol Use Disorder is now the diagnosis for people who meet at least 2 of the following criteria over a 12-month period of time:  

  • Alcohol is often taken in larger amounts or over a longer period than was intended. 
  • There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 
  • A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 
  • Craving, or a strong desire or urge to use alcohol. 
  • Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 
  • Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 
  • Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 
  • Recurrent alcohol use in situations in which it is physically hazardous. 
  • Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. 
  • Tolerance, as defined by either of the following:

  1. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. 

  1. A markedly diminished effect with continued use of the same amount of alcohol. 
  • Withdrawal, as manifested by either of the following: 

  1. The characteristic withdrawal syndrome for alcohol  

  1. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms. 

Note that there is no mention of powerlessness, character defects, or spiritual malady.  This is a medical condition, not a spiritual disease.  Many people, in fact most, manage and/or control their alcohol problem without adopting an alcoholic label, joining a 12 Step program, or engaging in faith-based practices.  

In fact, research from the NIAAA’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), NIAAA Spectrum (nih.gov) shows that more than half of those who cease to meet the criteria for Alcohol Use Disorder are able to drink at safe and moderate levels. Think of all the cliches you’ve heard: “Once an alcoholic, always an alcoholic,” “You can’t turn a pickle back into a cucumber.”  The idea that once a person has experienced Alcohol Use Disorder, they cannot drink again safely has no basis in fact.  Moderation is a reasonable long-term goal for some patients with Alcohol Use Disorder.    

The label “alcoholic” can become a self-fulfilling prophesy, programming anyone who wears it to think they are always in danger of uncontrollable drinking.  Common mythology encourages problem drinkers to believe that one sip of alcohol spells automatic doom.  This perpetuates a cycle of abstinence and binging, which is often more dangerous than the original problem.   

If you’ve ever been to an Alcoholics Anonymous meeting, you’ve likely seen people who have not had a drink in many years introducing themselves as “alcoholics,” talking about the effect alcohol had on their lives (no matter how long ago) and bemoaning the fear of relapse.  “Your disease is doing push-ups in the parking lot while you’re in here,” is a common saying at AA meetings and rehabs. The implication is that Alcohol Use Disorder is getting worse, even while a person is abstinent, and that living in fear of a return to use is the only possible response.  While vigilance has its place, constant ruminating on a problem has a habit of perpetuating it.  Identifying by the label “alcoholic” places the problem at the center of your identity and your thoughts, making it less likely that you will move on to a healthy place in life, whether you give up alcohol or not.  

At NorthStar Care, we know that support, proper medical treatment including medications and nutrient repletion, and skills to manage emotions can help anyone recover from Alcohol Use Disorder, no shame or stigma required.  We call people by whatever name they choose and respect their identities.  We encourage everyone to ditch the label and recognize that every person has the power to recover and life a full, vibrant and satisfying life – label free! 

April Wilson Smith, MPH

April Wilson Smith, MPH