If you are a loved one - a friend or family member - of an alcoholic, you may ask yourself this question a lot.
If you are drinking and can't stop, if you are drinking without your own permission, you may be asking yourself the same sort of questions: what is WRONG with me? Why can't I just stop?
In recent weeks I have had several conversations with people, on both sides of this equation, who are wondering these things. It's an odd feeling, trying to explain something so complex and so personal for me. Typically, when asked, I will share some of my own experiences, try to help people understand through the lens of my own addiction and recovery. But everyone is different - there is no blueprint for the way alcoholism presents itself, or progresses. There is, however, one thing that is known by the medical and scientific community to be true.
Alcoholism is a disease. The National Institute on Alcohol Abuse and Alcoholism says the following:
Alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems.When I was in treatment, and they were explaining the biological roots of alcoholism to me, it was freeing. Finally, I was able to understand that I had a disease that I could no more control than I could if my body was fighting cancer, diabetes or asthma. Will power had nothing to do with it, any more than will power would come into play if my body didn't produce enough insulin, or my cells had turned cancerous.
Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle. (See also "Publications," Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.)
I have heard - even in the alcoholic/recovery community - from people who don't agree that it is a disease. I have heard from loved ones that the disease concept makes them fearful - that it enables someone struggling with alcoholism to throw up their hands and say, "See? I can't help it!"
I look at it this way: my disease is organic, it is biologically based like an allergy. I didn't choose to be an alcoholic, or invite this disease to attack me through weak moral character or a lack of will power. All I needed to do to awaken the seed of alcoholism that lay dormant in me was to drink alcohol. Something I hear over and over in recovery meetings, and I identify strongly with, is people describing how drinking felt to them at first - like a light switch clicked on inside of them, that they had found something they had needed all their lives.
I didn't have any choices once I drank - one drink and I couldn't predict what would happen. I always drank with the intention of having only one or two. I never set out to have too much, to ruin my health, my mental and physical well being. This is why the allergy comparison feels so right to me - my body and mind react differently to alcohol, and it happens the minute I put alcohol in my system.
My disease may be organic, but my recovery is my responsibility. I relapsed over and over as I struggled to get sober, and I look back at that time and try to figure out what the common denominator was, why for so long I couldn't stop, and then why I did, finally I hope, get sober.
I don't know that I'll ever have one answer for this question, but one fact remains clear to me: until I understood that I was powerless over alcohol - that one drink triggered all the other stuff - I didn't have a chance. For me, learning that alcoholism was a disease was the final piece that had to click into place. Once I understood that will power not only didn't count, but was making things WORSE, I stepped out of the way and asked for help. The same way I would if a doctor solemnly told me I had diabetes, the only question I needed to ask was "what do I need to do?"
The treatment plan revolves around staying away from that first drink. For me, it is recovery meetings, prayer and the comfort of talking with people who understand. It is a disease that convinces you that you're not sick. Once you feel physically and mentally better, once the wreckage caused by drinking is repaired, it is easy to believe you're okay now, that you can control it. I go to recovery meetings and talk to other people in recovery to stay close to the fact that I can't drink in safety, to maintain my defense against that first drink (I go to meetings for so many more reasons than that, but that is a discussion for another time).
The other question that is asked by people struggling with their drinking and their loved ones is: how do I know if I'm an alcoholic? My response is always this: it doesn't matter how much, or how often, it matters what it does to you.
There are countless quizzes and checklists out there, but I like this one by the NIAA because it is short, to the point:
Have you ever felt you should cut down on your drinking?
Have people annoyed you by criticizing your drinking?I like this checklist because it cuts to the chase - 'regular' drinkers don't spend any time worrying about their drinking, or feeling guilty about it. So many people are diagnosed after their life has become a roiling mess, and it is beyond clear to everyone involved that drinking is at the root of the problem. This checklist could help people catch their disease in its earliest stages, when the niggling doubts and fears are mostly internal.
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
One "yes" answer suggests a possible alcohol problem. More than one "yes" answer means it is highly likely that a problem exists.
If you are struggling with alcohol, if you answered yes to one or more of the questions above, please get help. A physician is a good place to start if you're not ready to talk with loved ones or walk into a recovery meeting.
Facing the truth is the biggest hurdle towards getting well. It takes courage - whether you're struggling yourself or you love someone who is - to tell the truth, to overcome the stigma of alcoholism and cut through denial.
If someone had any other chronic and fatal illness people wouldn't wonder if they were weak of character or will power. The stigma of alcoholism keeps people sick. Denial - on both sides of the equation - prevents the symptoms from being recognized.
The truth, however, could save a life, because alcoholism always, always progresses.