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Alcoholism in America – Part III: Decoding the Truth
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Alcoholism in America – Part III: Decoding the Truth

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A few weeks ago, we ran a piece on USA Really about drinking and driving during the Christmas and New Years’ holiday season. We addressed the issues of drunkenness, driving under the influence and irresponsibility in the US as regards the consumption of alcoholic beverages in the country during this time of year.

However we also made a distinction, that heavy drinking and alcoholism are phenomena of different, but overlapping, characteristics. Here we begin to discuss alcoholism itself, in hopes of demystifying this condition.

The facts on alcoholism prevalence in the world

The World Health Organization website has an interactive section in which one may observe the reported prevalence of alcoholism (called “alcohol use disorders” here) in males and females 15 years of age and older. This survey was conducted in 2004.

The prevalence of alcoholism in the US population is the 48th highest in the world at 5.48% among males, though the Eastern European countries, most notably the former Soviet Republics, have far higher alcoholism rates, with Russia’s 16.29% rate for males being the highest reported in the world.

The proportion of alcoholism among men and women in the US is interesting in that the reported incidence of alcoholism among women in comparison to men is the fourth highest in the non-Islamic world, and the reported rate of occurrence of alcoholism among women is the tenth highest in the world, at 1.92%.

This does not mean that women do not become addicted to alcohol as easily as men, but socially, women are less inclined to drink, often because the brunt of the horrific behavior of alcoholic men falls on them, so they eschew alcohol and in some places, openly fear it.

Alcoholism remains one of the most severely misunderstood illnesses in society. There are reasons for this, and we begin to examine two very important ones now.

Denial in the Alcoholic and Family

The misconceptions about alcoholism are many. The stats offered here should provide some opportunity for myth-busting, but even with these stats, one of the primary characteristics of the alcoholic is that he or she denies being one.

This creates a lot of statistical and diagnostic problems, because if the doctor is alcoholic, he or she will likely not diagnose someone alcoholic who is doing the same thing or less extreme things than he or she is. This mechanism, called denial in the treatment field, is very strong, and it results in alcoholics consciously or subconsciously aiding and abetting other alcoholics to keep drinking.

Denial also extends to the families and friends of alcoholics. The disease is horrible, so the response of loved ones is often to deny that their person has the disease because of the social stigma associated with it. It is exceedingly difficult to recover from alcoholism; indeed, impossible without a strong and very honest support structure.

Because of this factor, it is often avoided by those around the person, because to face it head on immediately appears to invite defeat and an angry outburst from the alcoholic who is confronted with the facts of their behavior.

If you want to be cool, you should break the rule

However, there are further blocks to an honest understanding of the disease that are compounded by a social perception of drinking that is rather unique to the United States.

To put it simply, the perception of drinking is: Drinking is wrong to do. It is a bit naughty to drink, and even a bit more naughty to get tipsy. To get drunk is socially disrespectful.

This perception in the US is subtle because it is pervasive throughout almost all of the native-born population in the United States. We notice, for example, that in Europe, people drink wine with meals as commonly as we drink Coca-Cola. We wonder at the legal drinking ages in countries like France and Germany, and many of our teenagers dream about going to Germany “to drink beer legally”, because in the US, the laws prohibit the purchase of alcoholic beverages of all kinds until the age of 21.

This is because the United States religious culture is predominantly Protestant, and that culture is infused with groups that in some cases forbade the drinking of alcohol in any form at any time. This means that almost everyone who drinks alcohol in the US has an overshadowing thought that “this is wrong!” and that there is a little bit of mischief associated with drinking, especially among the young. This is usually a thrilling sense, and even more so with the prospect of drinking enough to feel the alcohol go to work, to be tipsy or even drunk.

This is a situation that is also true to some extent in European nations, but in the US the religious culture magnifies it. Even for religious adherents of the Roman Catholic and Eastern Orthodox Churches, which culturally do not forbid drinking, the dominant cultural elements of Protestantism subtly override the religious sensibilities of all but the most dedicated religious Americans. For those who are serious adherents in Christian communities that do not forbid alcohol, drunkenness is seen as very wrong, and so the incidence of drinking to even some physical effect being felt is very low.

For that reason, even a sip of beer among Americans is seen as mischief, and in some groups, almost a crime or a sin.  

Interestingly enough, in an Orthodox Christian seminary, I observed that some American students who were converts to Orthodoxy were rather taken by the fact that alcohol is not condemned by the Church, and so they had an interest in drinking a lot “because we’re Orthodox and we can drink!” – this, of course, is not a Christian attitude at all, but the hijacking of the faith by those who are trying to justify away this sense of “it is wrong” that they carried into Orthodoxy.

Alcoholism gets a boost in its progression from this factor, though, as a disease, it can take hold of anyone at any time, regardless of this context. We elicit the social context because it is unique to the USA and the attempts of American society to deal with it have all fallen short, and continue to do so to this day.

Anyone who has ever done a deed perceived as wrong, mischievous, or sinful, is often likely to talk of it in a humorous manner, and indeed, this can get spun out to an enormous degree with alcohol. Consider comedic movies such as The Hangover, which actually got three sequels and the Golden Globe award for Best Motion Picture, or Animal House, which highlighted heavy drinking as the locus of college life.  The social image of drinking is “crazy things happen when you drink a lot and this is very cool!”

These factors encourage the development of the sense of mischief when drinking, and it is possible that it also encourages the type of drinking that initiates the onset of true alcoholism.

How does alcoholism actually start?

Statistics cannot be stated that support the notion that such an attitude causes alcoholism. However, among young people who became alcoholics, in the list of reasons they drank, we heard the following statements:

  • It was cool
  • The bigger kids were doing it
  • It was fun to do something wrong but not get caught
  • I felt like I was cool too because I was doing it
  • It gave me funny stories to tell others
  • I felt like I fit in with the people I looked up to.

These factors are very common among teenagers who drink (as well as use drugs aside from alcohol), but they are a little different than the legal adults who start drinking, completely legally:

  • A little wine (or something else) relaxes me
  • I can talk with people more easily after a few drinks
  • Fire for the imagination
  • Release from care, boredom and worry
  • A feeling that life is good

These observations reveal two different but similar sets of characteristics, and of course, they both are age and development appropriate.

However, when alcoholism develops, all this gets gradually swept aside, usually more rapidly for younger people than for older ones. All the joy, or at least the honest-to-goodness “having a good time” is gradually covered over by despair, compulsive drinking and a bevy of symptoms not common to the normal, even heavy drinker, which we can list here.

The Diagnostic and Statistical Manual of Mental Disorders gives the following criteria as manifestations of alcoholism in anyone who exhibits two or more of these symptoms occurring at any time in the same 12 month period:

  • 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.
    2. 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 
    2. Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

This detail of characteristics is verified through the experience of millions of recovered alcoholics. What is more important is that the DSM rightly notes that the manifestation of these symptoms does not have to happen very often.

One of the myths about alcoholism is that this is when a person drinks every day. This is not true. Some alcoholics drink only once a year or even more seldom. One story recounts how alcoholic drank three times in his whole life. But after the third drink he was incarcerated for killing someone. It is not necessarily how much one drinks, it is what happens when one drinks, after one drinks and even before one drinks.

Another man, sober now, described the experience of being an active alcoholic like this:

“The problem was not that I was drinking; the problem was that I kept getting sober all the time. I would find myself sober, and it was awful! The only thing that I could think of doing was to stop being sober, so I had to drink to stop being sober all the time…”

This is not seem to be a joyous experience. It is a hellish description of life, and this is the experience of many alcoholics.

How does an alcoholic stop drinking for good?

Most people who drink, even heavy drinkers, are not alcoholics. Given a sufficient cause, most people who drink a lot are able to stop drinking. But the real alcoholic cannot stop without help, and that help is not just through synthetic medical science. The experience of many real alcoholics says that they can only stop drinking as the result of a spiritual experience, and most of them describe this experience as a personal encounter of some type with God.

This is another reason why we pointed at the essence of mischief in the mind of the American drinker.  There is a spiritual aspect to alcoholism that cannot be denied if we are to truly be able to assess and treat the alcoholic.

The disease of alcoholism shares the characteristics of other medically known diseases such as diabetes, cancer and heart disease. All these share the following common features:

  • they are primary, meaning that they are the cause of all symptoms and problems in a person’s life.
  • Chronic – meaning that the disease never goes away. There is no cure.
  • Progressive – the disease always gets worse over time, never better.
  • Terminal -  The disease’s course ends when you die. It will kill you or you will die with it. There is no other choice.

Heart disease, cancer and diabetes can be successfully treated and driven into remission through physical means, such as a change of diet and medical procedures, or radiation / chemotherapy or surgery.

However, alcoholism’s treatment mandates a spiritual turnaround, and that turnaround is radical in its nature. It may start simply with the cessation of drinking, but the recovered alcoholic usually turns out to be a model citizen because they realize that in order to stay sober, they must remain close to God (as they understand God.)

For the alcoholic, God’s way is not merely a set of moral codes and rules to follow. His way is not a religious code, though traditional religious groups present the solution in their own practices. However, for the alcoholic this is not just rule-following, it is a connection to life itself, and as such it is the maintenance of a connection with God that keeps them sober.

One of the reasons we wrote about the social / spiritual connection in regards to early drinking is because this connection is not only restricted to alcohol. Alcohol use disorders, to borrow the term, are only a single facet of the diseased condition we can commonly call “alcoholism.”

Indeed, the truth of this is that someone with the condition need not even drink at all. This is one of the most fiercely denied facts regarding this condition, because it points at something that is increasingly feared and hated in American society – the adherence to traditional mores and values.

We will examine this in Part II.

Author: Seraphim Hanisch