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
