What Our Stereotypes Get Wrong About Alcoholism

Photographed by Alexandra Gavillet.
Quite a few of us have had those nights when we went out and drank too much — it's what many refer to as "college." And although we probably all know (from the hangover if nothing else) that this behavior is definitely not great for our health, we lived, right? Plus, everyone else seems to be doing the exact same thing. The problem with this, and the fact that so much of our social lives revolve around alcohol, is that it makes it far too easy for our relationship with alcohol to become problematic — and for our developing issues to go under the radar. We've also come to assume things about helping someone with an alcohol issue that just aren't true. For example, "Families and friends think they can’t do anything until the person bottoms out," says Carrie Wilkens, PhD, cofounder and clinical director of the Center for Motivation and Change. "I would love for that phrase to get completely eradicated from our vocabulary." Dr. Wilkens, who is one of the experts featured in Risky Drinking, a new HBO documentary premiering tonight at 8 p.m. EST, says that contrary to popular belief, it's not super clear-cut what constitutes an issue with alcohol. Instead, the symptoms of alcohol use disorder (which is the term used for a medical diagnosis) exist on a spectrum, from mild to severe. We talked to Dr. Wilkens about our changing understanding of alcoholism, how to spot a problem, and why AA or even total abstinence isn't the only treatment option out there.

What are some often overlooked signs of a developing problem?
"There are actually 11 symptoms of an alcohol use disorder. They're things like you're getting in risky situations like drinking and driving, or finding that you have to drink more to get the same effect, or you've tried to reduce your drinking and can’t quite do it. Maybe you're waking up with hangovers and losing half a day. "If you have two or three of these symptoms, you’re considered to have a mild problem; if you have four or five, that's a moderate problem, and if you have more than six, you have a severe disorder. "Binge drinkers tend to write stuff off as 'Oh, that was just one bad night.' [So it's important to] really be honest with yourself about how many hours did you lose the next day to hangover? What things did you do and say to people that you actually really feel bad about? How is it affecting your productivity? How is it affecting your self-care? "Heavy drinkers can get really used to feeling bad. They're used to feeling hungover, always having a headache or stomach problems. They've just gotten used to it. They literally don't remember what it feels like to feel healthy. That’s something to be attuned to — are you always waking up with a headache? Are you finding that you can’t really eat stuff in the morning because you feel queasy?"
How has our understanding of alcohol use disorders changed?
"You can hear how people talk about it still. They think, Am I an alcoholic or not? It’s very black and white — either you have a problem or you don’t. But research and clinical evidence all points to the fact that people have a range of issues, and for most people [the issues they're dealing with] shift throughout time. "You’ll see people drifting into a severe zone and then to a low-level problem and maybe they'll be there for a long period of time. Then maybe something will happen and they’ll go back to the more severe end. There’s a lot of people at a low level of severity but still having problems associated with their use of alcohol. And those are the people [thinking in the black and white paradigm who] don’t identify as an alcoholic because their problems are not that severe. But they’re still having problems."

Why isn't abstinence the best plan for everyone?
"That’s where this idea of a spectrum [of alcohol use disorder severity] can be really helpful. It used to be either you’re an alcoholic or you’re not. And, if you’re an alcoholic, you need to stop drinking. Period.

"But people who are on the mild or moderate end of the spectrum may or may not need to be abstinent for the rest of their lives. There may be a lot of behavioral things they can do that change their drinking patterns. You could possibly treat any underlying problems — maybe they’re drinking because they’re anxious or because they have trauma, and maybe if you treat those they’ll rely on alcohol less. "By saying, 'Hey, we’ll work with you wherever you want to start, and if you want to start to moderate we're going to try to work with that,' that opens the door to those people getting treatment. Historically, those people couldn't even talk about their moderation goals. And they would go out there in the world and try to do it themselves and flounder. But being in treatment and actually talking about the patterns and choices you’re making helps people at that end of the spectrum."

If you are struggling with substance abuse, please call the SAMHSA National Helpline at 1-800-662-4357 for free and confidential information.

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