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What is Alcoholism?

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

Alcoholism is a commonly used term that describes an impaired ability to limit alcohol use, despite the harmful consequences of continued use.  In this respect, alcoholism meets the definition of addiction. In our topic center on addiction, we define addiction:

Addiction is the repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

Alcoholism is not a diagnostic term recognized by American Psychiatric Association.  The correct diagnostic term would be alcohol use disorder (alcohol addiction).   The process of diagnosing alcohol addiction is discussed here.

Like all addictions, the severity of alcohol addiction may range from mild to severe.  Alcoholism generally refers to an extreme range of severity, but problems with alcohol use begin long before this degree of severity.  Unfortunately, many people mistakenly believe they do not need to be concerned about their alcohol use because they do not consider themselves "alcoholic."  In other words, people sometimes fail to recognize the substantial harm caused by their repeated and continued use of alcohol.  The following list may be helpful to identify the many possible ways that alcohol use may be harmful to someone:

a) Emotional costs of alcohol addiction: living with daily feelings of fear, anger, sadness, shame, guilt, paranoia, loss of pleasure, boredom, emotional instability, self-loathing (disgust with oneself), loneliness, isolation, and feelings worthlessness.

b) Social costs of alcohol addiction: disruption or damage to important relationships; decreased ability or interest in forming meaningful connections with others; and limiting one's social sphere to other unhealthy, addicted persons.

c) Physical and health costs of alcohol addiction: poor general health; poor personal hygiene; lowered energy and endurance; diminished enjoyment of sex or sexual dysfunction; poor sleep; and damaging the health of an unborn child.

d) Intellectual costs of alcohol addiction: loss of creative pursuits; decreased ability to solve problems; and poor memory.

e) Work and productivity costs of alcohol addiction: decreased productivity in all aspects of life; missing important deadlines and failing to meet obligations; impaired ability to safely operate tools and equipment (including driving); and lost time due to accidents arising from being impaired (e.g., falling and breaking a leg).

f) Financial costs of alcohol addiction: money spent on the addiction itself; money spent dealing with the consequences of addiction (healthcare costs, legal costs, etc.).

g) Legal costs of alcohol addiction: legal costs because of what someone did while engaging in their addiction (DUI, bar fights, domestic violence, divorce); or did not do (failing to care for children properly).

h) Lost time due to alcohol addiction: Time is a limited resource. Time spent while intoxicated is no longer available to spend in meaningful, life enriching activities. Meaningful, life-enriching activities are of two basic types: 1) love - time spent in relationships with others, and 2) work - time spent being productive including employment, learning, working on personal projects, volunteering, and helping others.

i) Diminished personal integrity due to alcohol addiction: Most people have a strong sense of morality. This includes a sense of what is right and wrong; what one ought to do (and not do); how others should be treated; and a sense of responsibility toward one's family, community, employer, and to society as a whole. However, a tiny percentage of people (roughly 1%) seem to be missing this sense of morality. Such people are often termed sociopathic, psychopathic, or antisocially disordered. Although the terms are not identical, they are similar enough for our purposes. This sociopathic 1% of the population will commonly develop addictions. Unfortunately, if someone in the other 99% of the population develops an addiction they will begin to behave in a manner similar to sociopaths. As their addiction progresses, they begin to lose their morality and integrity.

As addicted people gradually lose their moral compass, they begin to disrespect the rights and needs of other people. They even mistreat the people that matter to them most. This initially begins by failing to meet certain responsibilities, commitments, or obligations. Examples of these failures might be, failing to show up for things; becoming dishonest by failing to disclose information; or making excuses rather than making a sincere apology. This type of disregard will evolve into more obvious forms of disrespect and mistreatment as addiction progresses. This progression might include flat-out lying and deception; stealing from loved ones; and threatening these same people if their demands are not met. Unlike their sociopathic counterparts who lack a moral compass to begin with, people who once had a moral compass experience tremendous feelings of guilt and self-loathing as they break their own moral code. Addiction can only relieve these feelings temporarily.

j) A life that is absent of meaning and purpose due to alcohol addiction: This cost is perhaps the ultimate one.  For some, this loss takes the form of experiencing a separation and estrangement from their religious or spiritual beliefs. It might be a feeling that one has failed by not fulfilling a higher purpose in life. For others, it means losing the meaning and purpose of life. This meaning and purpose is ordinarily derived from our loving involvement with other people and a sense of purpose that occurs from our productive activities (work, learning, achievement, contribution to others, etc.) In either case, addicted persons have traded away these essential ingredients to life satisfaction for the sake of pursuing momentary pleasures, and/or momentary relief from emotional suffering."