Are You an Addict, a Normie—or Neither?
Are You an Addict, a Normie—or Neither?
“I see myself in a gray area,” says Ian, a 30-year-old sales professional from Brooklyn. “Alcohol caused me problems, so, sure, I had a problem. I was binge drinking a lot—I hit double figures [for drinks] at least one night every weekend. It was bad for me physically, I got in fights, did and said stupid things, damaged relationships and some days missed work.”
But after a peak between ages 21 and 25, he found that his drinking declined: “There isn’t one point where I could say it happened; it just became rarer for me to get seriously drunk.” In the last three years, he says, “the worst consequence I had was some headaches. Alcohol is still a big part of my social life; it’s a positive, fun experience. I just don’t go crazy anymore.”
So what happened? Is he or isn't he an alcoholic? Ian credits the change in his life mainly to external circumstances that “made me want to get wasted less,” such as an improvement in job prospects, some different friends and “just growing up a little, I guess. I’m happier now, and that means you don’t drink the same way.” As for a problem-free future, “I don’t know for sure. I just feel I have a good chance.”
“I'd wager no drinker could read this list and not answer yes to at least one question. Is everyone an alcoholic?”
It’s not rare to hear stories like Ian’s. But people like him are at the center of a raging debate this year. Should addiction retain discrete diagnoses—like the American Psychiatric Association’s “alcohol abuse” and “alcohol dependence,” or the AA parlance of “alcoholic” and “normie”? Or can substance problems more accurately be placed on a spectrum—with more shades of gray than the most-read erotic novel on the subway right now—that would overturn generations of conventional views of addiction as an either/or proposition?
This idea pokes at wasps’ nests within both the psychiatric community and the recovery community, where 12-step literature and traditions revolve around definitive self-identification as an alcoholic or addict.
Two publications this March added fuel. First came a survey from the Partnership at Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services. It found that 10% of Americans aged 18 and up answer “yes” to the question, “Did you once have a problem with drugs or alcohol, but no longer do?”
So an estimated 23 million US adults put themselves in the category of “had-a-substance-problem-but-don’t-now.” There’s nothing controversial in that. But it begs the question of who they all are. Most aren’t in 12-step or alternative programs—AA, easily the largest such fellowship or group, puts its US membership at just under 1.3 million. While a third of US adults don’t drink, does “no longer having a problem” mean total abstinence in every case?
Anecdotal evidence suggests that plenty of those who say they've overcome a previous problem aren’t sober, and don't define themselves as addicts. These people might interest authors Robert Doyle and Joseph Nowinski—a clinical psychologist and a clinical instructor in psychiatry respectively. Their book, Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem? was also published last month. “The almost alcoholic zone is actually quite large,” they wrote in The Atlantic. “The people who occupy it are not alcoholics. Rather, they are men and women whose drinking habits range from barely qualifying as almost alcoholics to those whose drinking borders on abuse.”
Their intervention comes in the context of the American Psychiatric Association’s apparent consideration of “a paradigm shift in the way we view mental illness, including substance use” for inclusion in the next edition of its powerful Diagnostic and Statistical Manual, potentially moving towards Doyle and Nowinski’s belief that “some conditions might be better thought of as existing on a spectrum rather than in terms of discrete categories such as alcohol abuse and dependence.”
This “might be viewed by some as opening the door to over-diagnosing the associated problems,” they argue. “We believe the opposite will prove to be the case: that this paradigm shift will allow people to recognize problems earlier and to seek solutions without having to be labeled as alcoholics.”
So who are the people who say they’ve had a problem in the past, yet don’t practice abstinence—and who might populate the middle reaches of a spectrum view of addiction? And how do they define themselves?
Mark, 35, a producer from London, moved temporarily to another city eight years ago, where he had a hard time and found that his drinking began to get out of control, “culminating in a need to drink in order to feel normal. I found myself drinking every day, and eventually every day from morning till night. Obviously at this point both my social life and professional life were heavily affected.” He would also put himself and others in danger: “I would spend whatever money I had and risk driving just to find more alcohol.”
These problems lasted several years. But without professional or group support, he started cutting down significantly about five years ago. “I drink so much less,” he says now. “My working life has not been interrupted by drinking in a long time.” He describes his current drinking habits as “essentially miniature versions of how they were; I still drink socially, on occasion to excess, and I still drink alone maybe once or twice per week.” However, “Now drinking alone will rarely if ever exceed two drinks.”
Why the change? “I engaged with it and took control of the situation,” he says. He also cites “an emotional attachment that no longer exists” as partly to thank. “Key elements for me are my ability to moderate, and maybe more importantly my desire to moderate.” He does admit, “I occasionally get the sense that I'm vulnerable to veering back into drinking too much. When I feel that, I keep a check on the situation and make sure I'm disciplined.”
Ian says that while joining AA never really occurred to him, “If I’d met the right people when my problems were bad, I could easily have been convinced to join. But I’m relieved now that it didn’t happen.” Mark did consider AA during his toughest period, but “decided that abstinence wasn't the way for me. I'm sure it's the correct route for some and can be successful and necessary…but I find the idea of abstinence being the only path restrictive and potentially damaging.” He argues, “For me, I think that way of thinking would have led to a situation where a life controlled by drink would have simply been replaced by a life controlled by not having a drink.”
Storylines like those of Ian, Mark and the other sources in this article can expect a skeptical reception in 12-step circles. The view there that being an alcoholic or an addict should be self-identified gives us one set of answers: none of our sources for this article identify as such.
On the other hand, our group has a more problematic relationship with the Twenty Questions to self-diagnose alcoholism that are widely distributed within the fellowship—with the guideline that answering “yes” to three or more either means (depending on where you read them) that you “may be” an alcoholic or that you’re “definitely” an alcoholic. Our five sources all answer “yes” to between three and seven of these questions, and are likely to be seen simply as alcoholics and addicts in denial by many in the recovery community.
That said, it doesn’t take much imagination to apply affirmative answers to three of the questions—“Have you ever felt remorse after drinking?”; “Do you drink alone?” and “Have you ever had a complete loss of memory as a result of your drinking?”—to a light drinker whose only booze problem consisted of an isolated, youthful indiscretion.
Lee, a 30-year-old writer from Brooklyn, makes this point: “I'd wager no drinker could read this list and not answer yes to at least one question. Is everyone an alcoholic?” A current drinker, he formerly had a problem with heroin and opiate painkillers.