How does it happen that some people become alcoholics, while most who drink do not? This is a question that haunts people who are troubled about alcohol, and it is a question that, in the end, seems to have no easy answer. Perhaps people who choose alcohol as a way of coping with life are not too different from persons who choose overeating, or working too much, or gambling, or spending too much money, or becoming too dependent upon other people. All seem to need an extra measure of outside reassurance in order to live comfortably. All seem unable to summon up the inner resources that exist somewhere within us to sustain us in difficult times. It’s as if they need constant validation.
All theories about the causes of alcoholism seem to contain some of the truth of the matter, but none fully answers the haunting question of why it happens. Perhaps it is not even an appropriate question. Looking for causes inevitably encourages fault-finding, blaming, guilt, self-pity, and recriminations. And the whole process doesn’t really solve anything. Perhaps, instead, we should be looking at how alcoholism develops – at the patterns and the signs.
Most people who drink do so for pleasure, without feeling particularly self-conscious about it, and without worrying too much about it one way or the other. For these people, alcohol is something to be enjoyed, occasionally alone but more often with friends and family. They have standards about alcohol use that they adhere to more or less dependably.
The American Medical Association defines alcoholism as “an illness characterized by preoccupation with alcohol and loss of control over its consumption such as to lead usually to intoxication if drinking is begun; by chronicity; by progression; and by tendency toward relapse. It is typically associated with physical disability and impaired emotional, occupational, and social adjustments as a direct consequence of persistent and excessive use of alcohol.”
When one’s drinking is out of control either frequently or now and then, it’s no longer so much a matter of choice as a compulsion. In this stage, too, there can be periods of remission: the alcoholic may carefully abstain or control drinking for periods of time – days, weeks or months – before another episode of uncontrolled drinking. Or perhaps there is no remission at all. It seems that once one has experienced loss of control through drinking, survived the experience, and returned to this experience again, something changes within the whole person, and the risk of creating that experience again is great. Similarly, people who have remained mildly intoxicated for many of their waking hours over long periods of time have great difficulty in living without alcohol, and the risk of loss on control is great. In both cases, the urge to drink supersedes thought – just before uncontrolled drinking recurs.
We know that alcoholics do not fit the humorous picture of the “happy lush” that we sometimes see on TV or in the movies. If alcoholics are pleasure seekers, they have chosen a difficult source of pleasure in heavy drinking, because the evidence is that most alcoholics report chronic fatigue, agitation, anxiety and depression. The very experience of becoming “high” involves changes in motor control and some measure of disorientation that can be pleasurable at first, but that can become increasingly painful, especially when there is some memory loss. Alcoholics rarely get good healthy sleep. Insomnia, nightmares, and exhaustion are often their bedfellows, even if they spend long hours in bed to avoid the stress of wakefulness.
Alcoholics often fail to eat properly; alcohol provides many empty calories, but a regular pattern of nutritious meals is often lacking. Alcoholics may experience an inability to concentrate at times when they are sober, as they carry with them into the day the anxiety and remorse of the hangover. Physically, intoxication is sometimes the pleasant experience they sought – sometimes not. But how much drinking and physical distress are required before we call this alcoholism?
Alcoholism is sometimes referred to as “the lonely illness,” and that description seems to fit pretty well. If we look at alcoholism as a social behavior, we see that it isolates the person from the society of others. Alcoholics usually find it difficult to be dependable in relationship with others. Little things trip them up: oversleeping because of a hangover and missing an appointment, arguing a point too strongly, insulting a mother-in-law that is a little to vivid, embarrassing a spouse or the children. As time passes, more serious social problems can develop: being fired from a job, alienating friends because of erratic behavior, getting arrested for driving while intoxicated. But how much inappropriate drinking and social isolation are required before we call it alcoholism?
The urge to feel “high” is a completely natural one. Little children love to get dizzy spinning around on a merry-go-round, swinging high on swings; people love the thrill of riding on a roller coaster. Long-distance runners talk about the ecstasy of breaking through the pain barrier. However, when people need to get high to face themselves and the tensions and pressures they perceive in their relationships with others, something is wrong. Alcoholics are people who have moved beyond the natural inclination to drink for pleasure and have entered into stress-relief drinking. They use alcohol as a temporary problem solver instead of the means to celebrate life. They use it to blot out negative feelings. These feelings may range all the way from vague notions of personal inadequacy, insecurity, and mild apprehension to serious to serious problems of self-hatred. Drinking simply increases the level of self-doubt, despite the temporary reassurance that it provides. But how much drinking and self-doubt are required before we call this alcoholism?
Maybe this blog post will encourage people to consider the facts about their own drinking. Help them recognize that they have experienced too much physical, social and emotional distress because of their excessive drinking – that they have crossed the thin line between social drinking and alcoholism. If so, I hope that they will take heart. I hope they will summon up the courage to ask for the help they so desperately need.