Alcoholism - Definition
Below are two definitions of alcoholism.
The first is from the National Council for Alcoholism and Drug Dependence
(NCADD) and represents, I believe, the prevailing orientation in the United
States today.
The second is from Stanton Peele, a prominent voice against the prevailing
views on addiction.
There are many others.
The debate goes on.
NCADD
"Alcoholism is a primary, chronic disease with genetic,
psychosocial, and environmental factors influencing its development and
manifestations. The disease is often progressive and fatal. It is characterized
by continuous or periodic: impaired control over drinking, preoccupation
with the drug alcohol, use of alcohol despite adverse consequences, and
distortions in thinking, most notably denial."
"Primary" refers to the nature of alcoholism as a disease
entity in addition to and separate from other pathophysiologic states which
may be associated with it. "Primary" suggests that alcoholism,
as an addiction, is not a symptom of an underlying disease state.
"Disease" means an involuntary disability. It represents
the sum of the abnormal phenomena displayed by a group of individuals.
These phenomena are associated with a specified common set of characteristics
by which these individuals differ from the norm, and which places them
at a disadvantage.
"Often progressive and fatal" means that the disease
persists over time and that physical, emotional, and social changes are
often cumulative and may progress as drinking continues. Alcoholism causes
premature death through overdose, organic complications involving the brain,
liver, heart and many other organs, and by contributing to suicide, homicide,
motor vehicle crashes, and other traumatic events.
"Impaired control" means the inability to limit alcohol
use or to consistently limit on any drinking occasion the duration of the
episode, the quantity consumed, and/or the behavioral consequences of drinking.
"Preoccupation" in association with alcohol use indicates
excessive, focused attention given to the drug alcohol, its effects, and/or
its use. The relative value thus assigned to alcohol by the individual
often leads to a diversion of energies away from important life concerns.
"Adverse consequences" are alcohol-related problems
or impairments in such areas as: physical health (e.g., alcohol withdrawal
syndromes, liver disease, gastritis, anemia, neurological disorders); psychological
functioning (e.g., impairments in cognition, changes in mood and behavior);
interpersonal functioning (e.g., marital problems and child abuse, impaired
social relationships); occupational functioning (e.g., scholastic or job
problems); and legal, financial, or spiritual problems.
"Denial" is used here not only in the psychoanalytic
sense of a single psychological defense mechanism disavowing the significance
of events, but more broadly to include a range of psychological maneuvers
designed to reduce awareness of the fact that alcohol use is the cause
of an individual's problems rather than a solution to those problems. Denial
becomes an integral part of the disease and a major obstacle to recovery.
Approved by the Boards of Directors of the National
Council on Alcoholism and Drug Dependence, Inc. (February 3, 1990) and
the American Society of Addiction
Medicine (February 25, 1990).
This definition was prepared by the Joint Committee to Study the Definition
and Criteria for the Diagnosis of Alcoholism of the National Council on
Alcoholism and Drug Dependence and the American
Society of Addiction Medicine:
Convenors: Robert M. Morse, MD, Joint Committee Chairman; Daniel K.
Flavin, MD, NCADD Medical/Scientific Director
Members: Daniel J. Anderson, PhD; Margaret Bean-Bayog, MD; Henri Begleiter
MD, PhD; Sheila B. Blume, MD, CAC; Jean Forest, MD; Stanley E. Gitlow,
MD; Enoch Gordis, MD; James E. Kelsey, MD; Nancy K. Mello, PhD; Roger E.
Meyer, MD; Robert G. Niven, MD; Ann Noll; Barton Pakull, MD; Katherine
K. Pike; Lucy Barry Robe; Max A. Schneider, MD; Marc Schuckit, MD; David
E. Smith, MD; Emanuel M. Steindler; Boris Tabakoff, PhD; George Vaillant,
MD
Members Ex-Officio: James Callahan, DPA; Jasper Chen-See,
MD; Robert D. Sparks, MD
Emeritus Consultant: Frank A. Seixas, MD
NCADD September 1996
Stanton Peele
Addiction can only be understood in experiential terms. No biological
subsystem describes addiction; no biological indicators detect addiction.
People are addicted when they pursue activities relentlessly and sacrifice
other life alternatives to this pursuit, and when they cannot face existence
without this involvement. We know people are addicted by their behavior
and experience: nothing else defines addiction.
Addiction must be understood in relation to an experience. This experience
is defined, in part, by the nature of the substance or the involvement.
For example, heroin produces an analgesic, depressant, and soporific experience;
cocaine and cigarettes create a different variety of drug experience. Gambling
produces an experience similar to the stimulant drugs, as does sexual excitement.
An insecure love relationship can have elements of both depressant and
stimulant experiences -- hence its remarkable virulence.
The other elements that determine the addictive potential of an experience
are the setting or environment in which it is undertaken, and the characteristics
of the individual who undertakes it. This was driven home by the Vietnam
experience, in which young men addicted to the pain-relieving experience
of heroin in the Vietnam environment rejected the same experience stateside.
Only some of these men -- those more likely to have had a negative sense
of their environment before going to Vietnam -- continued to be susceptible
to heroin addiction in the States.
The characteristics of an addictive experience (as perceived by a given
individual in a specific environment) are as follows: The experience is
1.powerful and all-encompassing;
2.inspires a sense of well-being, such as through conveying an artificial
sense of power or control;
3.is valued because of its predictability and thus its safety;
4.creates negative consequences that diminish the addict's concern for
and ability to relate to the rest of life.
When people in given life situations cannot gain a necessary sense of
power, control, safety, assurance, and predictability, they turn to and
rely on addictive experiences.
-From the Stanton Peele Web Site January 18, 1998
Alcohol & Drug Addiction - Self Diagnosis
Ask yourself the following questions:
- Do you lose time from work due to drinking or drug use?
- Is drinking or drug use making your home life unhappy?
- Do you drink or use drugs because you are shy with other people?
- Is drinking or drug use affecting your reputation?
- Have you gotten into financial difficulties as a result of drinking
or drug use?
- Do you turn to lower companions and an inferior environment when drinking
or using drugs?
- Does your drinking or drug use make you careless of your family's welfare?
- Has your ambition decreased since drinking or using drugs?
- Do you crave a drink or drugs at a definite time daily?
- Do you want a drink or drugs the next morning?
- Does drinking or using drugs cause you to have difficulty in sleeping?
- Has your efficiency decreased since drinking or using drugs?
- Is drinking or using drugs jeopardizing your job or business?
- Do you drink or use drugs to escape from worries or trouble?
- Do you drink or use drugs alone?
- Have you ever had a complete loss of memory as a result of drinking
or drug use?
- Has your physician ever treated you for drinking or drug use?
- Do you drink or use drugs to build up your self-confidence?
- Have you ever been to a hospital or institution on account of drinking
or drug use?
A Yes to three or more questions indicate abuse or addiction is present
and corrective steps need to be taken.
Questions are courtesy of Johns Hopkins University Hospital, Baltimore,
Maryland
Alcohol & Drug Addiction - Other Person Diagnosis
If you think you may be affected by a friend, co-worker, or family member
with an alcohol or other drug problem, the following test can help you
determine if your suspicions are founded. Answer each question with a "yes"
or "no."
- Are you ever afraid to be around the person when he or she is drinking
or using drugs because of the possibility of verbal or physical abuse?
- Do you worry about the person's drinking or drug use?
- Has the person broken promises to control or stop his/her drinking
or drug use?
- Have you ever made excuses for the way the person behaved while drinking
or using?
- Do you feel guilty about the person's drinking or drug use?
- Do you feel anxious or tense around the person because of his or her
drinking or drug use?
- Are you afraid to ride with the person after he or she has been drinking
or using?
- Have you ever lied to anyone else about the person's drinking or drug
use?
- Have you ever helped the person "cover up" for a drinking
or using episode by calling his or her employer, or telling others that
he or she is feeling "sick"?
- Have you ever been embarassed by the person's drinking or drug use?
If you answered "yes" to three or more of these questions,
then there is a good chance that the person you care about has a drinking
or drug problem. If you answered "yes" to any five, the chance
is even greater. And if you answered "yes" to seven or more,
you can feel safe in assuming that the person you care about needs help.
Johnsn Institute September 1996
Computer / Internet Addiction - Self Diagnosis
Ten Symptoms of Computer Addiction (by James Fearing, Ph.D.)
- A demonstrated "loss of control" when trying to stop or limit
the amount of time on the computer. (Breaking promises to self or others.
Promising to quit or cut down and not being able to do so)
- Being dishonest or minimizing the extent of the time you stay on the
computer, or covering up or being dishonest about what activities you participate
in when on the computer.
- Negative consequences experienced by the computer user or his/her friends
or family as a direct result of time or activities spent on the computer.
- Participation in high risk or normally unacceptable behaviors when
using the computer. Compromising your morals and values based on the opportunity
to remain anonymous and protected on the computer. (a good test for this
is to ask yourself if your spouse, partner or family would approve of what
you were doing on the computer)
- An overdeveloped sense of importance for the computer in ones life.
Defending your right to use the computer as much as desired, regardless
of the fact that people in your life are feeling left out and neglected.
(denial of the problem and justification; not being able to hear or feel
what the other people are saying regarding your computer behavior)
- Mixed feelings of euphoria (a "rush"), combined with feelings
of guilt brought on by either the inordinate amount of time spent on the
computer or the abnormal behavior acted out while using the computer.
- Feelings of depression or anxiety when something or someone shortens
your time or interrupts your plans to use the computer.
- Preoccupation with the computer and computer activities when you are
not using the computer (thinking about the computer and its activities
when doing something else; i.e. having a family dinner, working on project
deadline etc.)
- Finding yourself using the computer at times when you are feeling uncomfortable,
irritated, or sad about something happening in your life. ( feeling uncomfortable
in your relationship, so you will self medicate and "hide out"
on the computer) Using time on the computer to become externally focused
outside yourself as a way to avoid facing what is happening in your life,
and avoiding feeling the appropriate feelings inside yourself. (self medicating)
- Experiencing financial concerns or problems in your life as a result
of money being spent on computer hardware, computer on-line charges, or
any other costs associated with computers. (Spending money on computer
related items which should have been allocated to other normal living expenses)
If you said yes to one question you may have a problem with computer
addiction. If you said yes to two questions, there is a good chance you
do have a problem with computer addiction. If you answered yes to three
or more, you are demonstrating a pattern of behavior which would suggest
that you are addicted to your computer and/or the activities on it.
This questionaire was developed by James Fearing, Ph.D., at the National
Counseling Center in Minneapolis, MN.
Compulsive Gambling / Gambling Addiction - Self Diagnosis
Gamblers Anonymous offers the following questions to anyone who may
have a gambling problem. These questions are provided to help the individual
decide if he or she is a compulsive gambler and wants to stop gambling.
TWENTY QUESTIONS
- Did you every lose time from work or school due to gambling?
- Has gambling ever made your home life unhappy?
- Did gambling affect your reputation?
- Have you ever felt remorse after gambling?
- Did you ever gamble to get money with which to pay debts or otherwise
solve financial difficulties?
- Did gambling cause a decrease in your ambition or efficiency?
- After losing did you feel you must return as soon as possible and win
back your losses?
- After a win did you have a strong urge to return and win more?
- Did you often gamble until your last dollar was gone?
- Did you ever borrow to finance your gambling?
- Have you ever sold anything to finance gambling?
- Were you reluctant to use "gambling money" for normal expenditures?
- Did gambling make you careless of the welfare of your family?
- Did you ever gamble longer than you had planned?
- Have you ever gambled to escape worry or trouble?
- Have you ever committed, or considered committing, an illegal act to
finance gambling?
- Did gambling cause you to have difficulty in sleeping?
- Do arguments, disappointments or frustrations create within you an
urge to gamble?
- Did you ever have an urge to celebrate any good fortune by a few hours
of gambling?
- Have you ever considered self destruction as a result of your gambling?
Most compulsive gamblers will answer yes to at least seven of these
questions.
