What does it mean to be "alcoholic"? The DSM, psychiatry's diagnostic bible, does not have a category termed alcoholism per se, only diagnostic criteria for alcohol abuse and alcohol dependence. For many people with problematic drinking, physical dependence on alcohol is not an issue; they don't necessarily drink daily or suffer withdrawal symptoms beyond a hangover. Many problem drinkers therefore would deny that they are alcoholic because they think of the alcoholic as a daily drinker who requires a shot or two to get out of bed in the morning. Are they right?
Like many things in life which are not always black or white, alcohol use should be considered in the context of a continuum; alcohol can be used, abused, and depended upon, both physically and psychologically, but how one draws the distinction is hotly debated. Another consideration is that problem drinking is often progressive. What this means is that tolerance occurs over time, which means you need more and more alcohol to achieve the desired effect. Along with this increased tolerance comes impaired physical health and a host of other consequences. But this happens to all heavy drinkers over time and some would disagree that heavy drinking should always be considered "alcoholism".
As the former director of a substance abuse program and in my private practice, I have worked with hundreds of people in trouble with alcohol. Some call themselves alcoholics, some do not. Sometimes the people who are comfortable with that label can have less problematic drinking than those who deny it. I know of someone who had a liver and two kidneys transplanted due to drinking who denies being an alcoholic! I also know of people who are not generally problem drinkers but who have gotten a DUI or, in one case, hit and killed someone with a car, due to a single incident where they had too much to drink.
If you are reading this, you may be wondering if you are indeed "an alcoholic". Considering that not everyone agrees on precisely what defines "alcoholism" except in its more extreme and obvious cases, I would suggest that you might be asking the wrong question. Here are perhaps some better questions to ask yourself:
1. Would my life improve if I stopped drinking:
Would I get along better with significant others? Would I be better at my job ? Would I be a better parent? Would I feel better physically? Would I be more productive, sharp, on top of my game? And, perhaps most importantly, would I like myself better?
2. Do I notice that over time, I need significantly more alcohol to get the same kind of effect?
Did I used to get high on two glasses of wine and now I need 5 or 6? Or 8 or 10? And, if so, do I understand that alcohol in these quantities is damaging to every organ system in my body?
3. If I set myself a limit, can I consistently abide by it?
This to me is key. I often advise my clients who are debating with themselves if they truly have a problem with alcohol to try this little experiment: For one month, set yourself a limit on how many drinks you'll consume per day (or night). The limit should be set by you but should be within what would give a person of your gender, height and weight a pleasant buzz, perhaps 2 for women, 3 for men. Can you do it?
4. Does my personality or behavior become problematic when I drink?
Do others tell me I get nasty or belligerent? Do I get weepy and sad? Do I get into conflicts with others I otherwise would not? Do I have blackouts (periods while drinking where chunks of time can't be recalled)? Does my judgement become impaired?
So, in conclusion, whether or not you identify as alcoholic or not, if you answered yes to the first two questions, no to the third, and yes to the fourth, if I were you, I'd seriously consider giving up alcohol.