Are you an Alcoholic?

People who want to know whether or not they are alcoholics usually aren’t. People who are alcoholics tend to be absolutely convinced that they are not. They may accept that they have some problems with alcohol - but they believe that they are absolutely, definitely not alcoholic.

The diagnosis of alcoholism is usually made by other people long before the individual comes to accept it. Some people die from alcohol-related conditions without ever accepting that alcohol was an enemy to them rather than a friend. Even family members and doctors may shy away from making that fateful diagnosis because they may see it as a disgrace or a depravity, or at least a failure of willpower, rather than an illness. In fact it does not: someone who is alcoholic may not be responsible for being an alcoholic but he or she is certainly responsible for his or her behaviour towards other people.

The most remarkable difficulty in diagnosing alcoholism is that doctors are not taught about it in medical school. They are taught about the consequences of alcoholism but not about the illness itself. Generally they would have no idea on how to treat it other than to encourage people to "drink sensibly" - which is exactly what alcoholics cannot do.

In fact a great deal of trouble comes from the whole concept of "sensible drinking". Some doctors are absolutely determined that patients shall learn to drink sensibly. They may have personal motives for this: they may be determined to do so themselves. Alternatively, those doctors who are not alcoholics themselves may believe that the only reason they are not is that they have sufficient willpower. They may then be determined to encourage, or even force, patients into developing similar willpower. That does not work at all. If anything, alcoholics have too much will power. They go on and on year after year trying to prove to themselves and to everybody else that they are not alcoholics. Consequently they get a great deal of damage that could otherwise have been avoided by accepting the correct diagnosis earlier.

A further confusion comes as a result of some cultures being associated with heavy drinking. For example, university students tend to knock it back. That does not mean to say that they are all alcoholics: it simply means that they are university students - it is part of their culture. Soldiers, publicans, people who work in the media - there are many groups that drink more than the average level. These are sometimes seen as "high risk" groups, with the implication that if you go into that profession you are quite likely to become alcoholic. The truth is the other way round: alcoholics tend to be drawn towards those professions or cultures. This emphasises a very important point: alcoholics are born rather than made. There is probably a genetic predisposition resulting in a defect of neurotransmission in the mood centres of the brain. Neurotransmitters are the small chemicals that transmit nerve impulses from one nerve cell to another. If that junction does not work properly in the mood centres then the result will be that the person will feel depressed "for no reason". Thus depression and alcoholism (or addiction of any kind) are in fact the same thing and should be contrasted with sadness, which is simply a reaction to unhappy circumstances.

Ideally, therefore, the diagnosis of alcoholism should be made on genetic analysis - but this is not yet available. As the human genome gets gradually worked out in full over the next ten to twenty years, it will be possible to identify people with an addictive nature.

Before that unhappy time (it will certainly be unhappy for people who have the genetic tendency because there will be clamour for them to be aborted before birth and there will be all sorts of legal complications when people try to work out who is responsible for what) we have to rely upon behavioural characteristics. Alcoholics can in fact be diagnosed on the following questions:

1. Pre-occupation with use or with non-use.
2. Preference for, or contentment with use alone.
3. Use as a "medicine", to help relax or sedate or to stimulate.
4. Use primarily for mood-altering effect.
5. Protection of "supply", preferring to spend time, energy or money in this way.
6. Repeatedly using more than planned so that the first use tends to trigger the next.
7. Having a higher capacity than other people for using the substance or process without obvious initial damaging effects, although in this time this "tolerance" is lost.
8. Continuing to use despite progressively damaging consequences.
9. "Drug" seeking behaviour, looking for opportunities to use, and progressively rejecting activities that preclude use.
10. "Drug" dependent behaviour, "needing" the addictive substance or behaviour in order to function effectively.
11. The tendency to "cross-addict" into other addictive substances or processes when attempting to control the use of a particular one.
12. Continuing to use despite the repeated serious concern of other people.

If you have four of these characteristics then you probably have an addictive nature. You certainly have more than a social relationship with alcohol and you are not going to be able to sort it out yourself. You will need help.

Unhappily, yet again, the help that you will be offered will probably be an anti-depressant (which forms the base of yet another addiction) or Antabuse (which is designed to make you feel ill if you do drink - thus punishing you for a compulsion) or you will become a dry-drunk (which means that your mood and behaviour will be abominable as you struggle to avoid "treating" your genetic defect by using alcohol to make yourself feel better).

This highlights another major confusion. The word "alcoholism" implies that the illness comes about as a result of drinking too much alcohol. In fact alcohol is one of the "treatments" for the underlying mood disorder. We would not call a sore throat Penicillinism, naming the disease after one of its treatments. Correspondingly, we should not call alcoholism by that term. Alcohol is just one of many "treatments" for the underlying mood defect of addictive disease which, perhaps, will one day be termed "neurotransmission disease".

Furthermore, all the other "treatments" (cocaine, heroin, LSD, cannabis, Ecstasy, sugar and white flour, anti-depressants, tranquillisers, sleeping tablets, painkillers, nicotine, caffeine and other substances and processes that addicts discover for themselves) have an addictive mood-altering effect and must also be avoided. Otherwise, the underlying addictive nature will simply blossom in another territory. Abstinence may avoid the specific problems in relation to alcohol but cross-addiction into something else simply substitutes another set of problems. Above all, the underlying mood disorder will persist and the general blaming and self-pitying behaviour will continue.

The treatment is to use a mood-altering process that has a beneficial effect. Work and exercise are often recommended but these can also be destructive when used addictively. The one process that has no downside is reaching out anonymously to help other people with the Anonymous Fellowships such as Alcoholics Anonymous. When one person (A) reaches out to help another person (B) anonymously, then it is the first person (A) who gets better. This was the magical discovery of the co-founders of Alcoholics Anonymous and it still works today.

In the UK there are currently 2,390 weekly meetings of Alcoholics Anonymous. Sufferers have discovered for themselves what works. Doctor’s need a bit of persuading. Therefore, if you really want to know whether you are an alcoholic, go to AA. You may not like it straight away because you may not want to face up to the fact that that is what your problem really is. However, it does work and nothing else does so it is where alcoholics need to finish up eventually if they are to avoid the grave. This is not a flippant comment: currently 100 people a day in the UK die of alcohol-related illnesses. Finding out if you are an alcoholic could save your life.

• Back to alcohol addiction treatment