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If we do not define alcoholism by the quantity and frequency of alcohol use or intoxication, then how do we know someone is an alcoholic?

Most people define an alcoholic as “the person who drinks more than I do.”

Conventional wisdom says that the alcoholic is a guy passed out on the street, bottle in hand, begging for money for his next drink. But alcoholics come in many flavors and the disease is progressive, so even the guy on the street started someplace else—often with a home, a family and a future. Some alcoholics drink daily and are visibly impaired. But many drink heavily only once per week and appear normal between drinking episodes. The amount of alcohol consumed during these episodes can vary from amounts that produce little visible impairment, to enough to produce a loss of consciousness.

Defining alcoholism contains two parts.

First, we look at the unfavorable results that are caused or associated with drinking. These consequences usually start with impairments in relationships, continue with problems at work and difficulties functioning in society, and end in damage to health. Not every person with a drinking problem moves through this progression in this order. But all suffer damages to their most important functions as people: the ability to have and maintain a family and a job, to be a well-behaved member of society, and to live life without severe health problems.

The second defining feature of alcoholism is loss of control over drinking. Alcohol addicts have far less control over when, where and how much they drink. Almost all try to control drinking but fail. This leads to shame and often accelerates the spiral of consequences. Loss of control can be subtle. Think of the co-worker who drinks too much at work events. The first time it’s a bad choice, but over time repeated episodes of inability to control drinking cause real problems, including being labeled as a weak-willed person. And once the label is applied it takes real effort to get it removed.

Over the last 20 years researchers have developed a much better understanding of the biology of behavioral control. At Ria Health we apply that knowledge to help disrupt the factors that impair that control. Ideally, the treatments we use can give our patients enough control to avoid the serious consequences of drinking.

In my upcoming blog posts, I will continue to provide medical and scientific viewpoints on reasonable alcohol use vs. alcoholism. If you have a topic you’d like to see discussed, please comment below, and I’ll do the best to address your interest.

And it goes without saying, if you’re having difficulties managing your drinking, I’m here to help you.

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