Seventy years ago, Bill Wilson, the co-founder of Alcoholics Anonymous, declared his powerlessness over alcohol. The failed businessman contended that, as an alcoholic, he had to “hit bottom” before changing his life and that sobriety could only be achieved through complete abstention.
For generations, Americans took these tenets to be true for everyone. Top addiction experts are no longer sure.
They now say that many drinkers can evaluate their habits and — using new knowledge about genetic and behavioral risks of addiction — change those habits if necessary. Even some people who have what are now termed alcohol-use disorders, they add, can cut back on consumption before it disrupts lives.
In short, say some of the nation’s leading scientists studying substance abuse, humans travel a long road before they become powerless over alcohol — and most never reach that point.
“We’re on the cusp of some major advances in how we conceptualize alcoholism,” says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. The institute is the nation’s leading authority on alcoholism and the major provider of funds for alcohol research. “The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence.”
Many of these people need not give up alcohol altogether. The concept of so-called controlled drinking — that people with alcohol-use disorders could simply curb, or control, their drinking — has existed for many years. Evidence now exists that such an approach is possible for some people, although abstinence is still considered necessary for those with the most severe disease.
The overall reassessment has been fueled by the groundbreaking National Epidemiologic Survey on Alcohol and Related Conditions, the largest and most comprehensive look at alcohol use in America. The project surveyed 43,000 people 18 and older in 2001 and 2002, and again in 2004 and 2005, with the results released in increments beginning in 2006.
This survey has been enough to convince even national addiction experts that they’ve been too narrow in their approach to alcohol disorders. But the findings are being further bolstered by research in genetics and psychology.
Perhaps the most remarkable finding of the epidemiologic study was how many Americans experienced an alcohol-use disorder (either abuse or the more severe dependence) at some point — and how many recovered on their own. About 30 percent of Americans had experienced a disorder, the research showed, but about 70 percent of those quit drinking or cut back to safe consumption patterns without treatment after four years or less.
Only 1 percent of those surveyed fit the stereotypical image of someone with severe, recurring alcohol addiction who has hit the skids.
The data suggest that there are two forms of alcohol disorders: one that fits the traditional view of alcoholism, in which the need for a drink takes over a person’s life, and a time-limited form in which people drink heavily for a period but then cut down and recover.
“It can be a chronic, relapsing disease. But it isn’t usually that,” Willenbring says.
Alcohol abuse is defined as use that repeatedly contributes, within a 12-month period, to the risk of bodily harm, relationship troubles, problems in meeting obligations and run-ins with the law. Alcohol dependence includes the same symptoms, plus the inability to limit or stop drinking; the need for more alcohol to achieve the same effect; the presence of withdrawal symptoms; and a consumption level that takes increasing amounts of time.
The other key finding from the survey is that, at least once in the previous year, 28 percent of adults had exceeded the daily or weekly limits at which drinking is considered low-risk.
For men, low-risk drinking is defined as no more than four drinks on any given day or no more than 14 drinks per week. For women, the limit is three drinks per day or seven drinks per week. (A standard drink is 12 ounces of beer, 8 to 9 ounces of malt liquor, 5 ounces of wine or 1.5 ounces of 80-proof spirits.) The majority of Americans who drink beyond these limits have mild to moderate disorders, meaning they occasionally have trouble controlling their intake, Willenbring says.
In the national survey, about half of the people who’d had an alcohol-use disorder recovered, enabling them to drink at low-risk levels without symptoms of dependence. “Some people are uncomfortable with that,” Prescott says. “It’s a safer prescription to tell someone to quit. But the studies suggest that a large proportion of people are able to cut down and aren’t out of control.”
Comments
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artichokeheart (anonymous) says…
Like I always say; It's a choice.
AreUNorml (anonymous) says…
I wonder if the new health care program will cover my mild to moderate alcohol-use disorder. Will I be kicked from the program if I continue with my drinking? After all, it is a disease, so it mustn't be my fault.
or is this a warning that this type of behavior won't be covered, so clean up our acts immediately?
sowhatnow (anonymous) says…
Why do women only get to drink half as much per week as men to be low-risk? I get the body weight issues - and frankly, they should just go with size and not gender...
Fixed_Asset (anonymous) says…
So.... alcoholism isn't a disease, it's a choice?
Cappy (anonymous) says…
It's a choice and a disease. Such things are rarely black or white. Many factors come together to influence behavior that impacts our health: genetic predisposition, availability, upbringing, culture, habit. A lot of things we do thinking it is solely our choice we do as a result of a combination of influences.
Cappy (anonymous) says…
Marion,
If I tie you down and inject you with certain chemicals, over time you will develop cancer.
If I tie you down and inject you with alcohol, over time you will develop alcoholism.
See, totally different! /snark off
notajayhawk (anonymous) says…
sowhatnow (Anonymous) says…
"Why do women only get to drink half as much per week as men to be low-risk? I get the body weight issues - and frankly, they should just go with size and not gender…"
It's actually a percentage-of-body-fat issue, not body weight. Women (on the average) get drunker quicker on the same amount of alcohol.
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Cappy (Anonymous) says…
"If I tie you down and inject you with alcohol, over time you will develop alcoholism."
Not entirely true. He will most likely develop a tolerance and suffer from withdrawal when you stop, but he may not actually have an addictive disorder.
This concept (pseudo-addiction) is usually seen with narcotic painkillers. Following major surgery or a severe accident, a person may develop tolerance and suffer withdrawal symptoms, and also meet some other criteria for addiction. Then one day a couple of years later they find a half-full prescription bottle in the medicine cabinet, left over because they stopped taking them when they no longer needed them, and flush the bottle away.