This article appeared recently on a popular website: the difference between social and problem drinking. Of course, social drinking isn’t a term we hear often in the treatment field, because it’s too vague to be of much use. Ask a hundred drinkers to define it, and you’ll get a bunch of different answers.
I’m reminded of the 51 year old socialite who insisted on describing herself as a social drinker because she rarely drank alone. Of course there was almost always a party somewhere, and she had a long list of wine-loving friends. Her definition of social drinking was therefore “alcohol consumed in the vicinity of other drinkers,” regardless of amount or effect.
The DSM5 divides alcohol use disorders into mild, moderate and severe, based on the number of symptoms experienced. All three qualify for a diagnosis and there’s nothing to prevent an individual from progressing over time from lower to higher severity. In fact, many do. Thus mild, moderate and severe might be characterized as a “snapshot” of how things stands at the time of assessment.
The design of the DSM, which is more glossary than encyclopedia, allows for one patient to qualify for more than one SUD. In many treatment settings, that’s the rule, not the exception. At a program specializing in trauma, a typical patient met criteria for several SUDs, plus at least one mood or anxiety disorder, and often yet another disorder involving eating, gambling, or compulsions. The attending psychiatrist could only shrug and say, “Welcome to the world of trauma treatment.” In practice, he and the program staff focused on the trauma symptoms, believing that to be the root of the others. Were they right? I wonder.
Here’s a symptom list for Alcohol Use Disorder (AUD).
- Alcohol is often taken in larger amounts or over a longer period than was intended.
- Persistent desire or unsuccessful efforts to cut down or control alcohol use.
- A great deal of time spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
- Craving, or a strong desire or urge to use alcohol. This can be measured using a validated scale.
- Recurrent alcohol use resulting in failure to fulfill major role obligations at work, school, or home.
- Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
- Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use in situations in which it is physically hazardous (like driving).
- Use continues despite knowledge of a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
- Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol.
- Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal) b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.
A minimum of two could qualify someone for an AUD diagnosis. Up to three suggests it’s mild; four to five symptoms indicate moderate severity; six means significant distress.
Unlike some disorders in the DSM, it’s possible to self-diagnose an alcohol disorder. Of course, most people don’t. Even when someone does, it’s ordinarily at a more advanced stage, when problems are numerous and difficult to dismiss.
Alcoholism isn’t something we like to acknowledge. But once we do, change is eminently possible.