The term alcoholism has long been retired from official alcohol clinical and policy guidance, abandoned as a reductionist and stigmatising label for problem drinking. Instead, alcohol use disorders, some including varying degrees of dependency, reflect the wider continuum nature of alcohol problems. Despite this, inappropriate references to “alcoholics” are ubiquitous in everyday narratives including mainstream media, undermining opportunities to reduce alcohol harms in a number of subtle ways.
One reason for over use of the alcoholism concept may be a lack of a common language to describe the nuances of heavy drinking behaviours. Alcoholism may be assumed to be synonymous with alcohol dependence, but it is inherently bound to stereotypes of hitting rock bottom and beliefs in its nature as a lifelong disease. The media rarely offers alternative problem drinking accounts other than the equally flawed spectacle of binge drinking, and in turn perpetuates an overly simplistic framework for the public to reference their own beliefs and attitudes against.
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Alcohol problems remain highly stigmatised, even compared to mental health issues, and so advocates of the disease model have long claimed that it removes the stigma of the addiction by shifting the blame from the person onto the illness itself or its mooted genetic roots.
But the evidence for the disease model’s blame alleviation potential is mixed. Whilst some studies have shown that genetic or disease model beliefs do have some potential stigma related benefits, they have also been shown to increase fearfulness amongst the general public. Further studies show a complex and mixed picture towards alcoholism beliefs and its socio-cultural influences, but at their core disease beliefs create a separation between a healthy “us” and a diseased “them”, potentially even increasing outgroup stigma. Whilst admitting to having a problem with alcohol may often be regarded as the crucial step, for many it is the existence of stigma that acts a major barrier to doing so. Even people who find recovery through adopting an alcoholic identity can find the process a difficult and internally conflicting experience.
Shifting perceptions away from the false binary of alcoholism and its inherent disease connotations has other important implications. From a public health perspective, the majority of England’s ten million drinkers at risk of alcohol-related harms are not addicted, at least not to the extent they would consider themselves as alcoholic. Even of the 1.6 million harmful drinkers, many do not consider their drinking as problematic, instead pointing to those with heavier consumption than their own. I see this “othering” as a valid form of denial; heavy drinkers often correctly assert that they are not alcoholics as they do not conform to stereotypical beliefs about alcoholics as dysfunctional and unable to exert any control over their drinking. This valid denial is facilitated by the culturally endorsed but artificial dividing line between alcoholics and everyone else. Whilst explanations for denial itself are also complex, the belief that only alcoholics need help undermines many heavy drinkers from contemplating change.
While there’s little research into this at present (though it’s currently the subject of my PhD research), other negative impacts of the disease model are better established. Self-efficacy is the belief in one’s own ability to make a change and is a key predictor of recovery amongst problem drinkers, yet is undermined by beliefs in alcoholism when compared to more nuanced “continuum” beliefs about drinking.
In simple terms, alcoholism is typically conceived as genetic and pathological in its nature, thus perceived as uncontrollable and requiring treatment or lifelong Alcoholics Anonymous attendance. When we apply this set of beliefs and expectations to the many drinkers who do not identify with the dominant idea of alcoholism, we undermine both their chances to recognise their drinking as something worth changing, and their beliefs that it is within their control to do so. Over-application of the term reinforces the misconception that all alcohol problems are severe, occur in a genetically distinct population, and require formal abstinence only treatment and medication.
The broad brush stroke of alcoholism appears all too often in public narratives. In 2015 when a controversial drug was made available with the aim of supporting harmful drinkers without severe dependency to cut down, headlines such as New £3 pill to ‘cure’ alcoholism can stop binge boozing were not uncommon.
It is not just tabloid journalism either: the Guardian has its very own alcoholism tag under which the majority of features on dependency are personal accounts in line with disease model, reinforcing this othering of alcohol dependence problems. Earlier this year it published a piece titled Alcoholism continues long after you stop drinking but the content of the article emphasised the extreme complexity and damage problem drinking can involve, while containing nothing supporting the title’s disputed assertion.
Even articles attempting to dispel the us versus them narrative around alcoholism can miss the mark. Earlier this year the established journalist and author Nick Cohen shared an engaging and honest article about his drinking, but the narrative was again fundamentally flawed. Whilst declaring himself “not an alcoholic” and examining the questionable scientific validity of the disease model, Cohen repeatedly returns the reader to a conflated and inaccurate notion of alcoholism. Granted, an alternative language is lacking, but it is the job of good journalism to find ways to responsibly explore and articulate such complex issues.
However to approach all alcohol problems through the lens of alcoholism may be akin to labelling anyone experiencing a period of low mood as clinically depressed. Whenever we choose the language of alcoholism outside of specific recovery contexts, we tar those people with assumptions that may have counter-productive effects. In turn, we reify a false separation between so-called alcoholics and everyone else, enabling othering and driving stigma. Sections of the media should lead the way in resisting the temptation to always reach for the over familiar and too often myopic alcoholic narrative.
The article was written by James Morris, a PhD student at London South Bank University. His research is exploring how beliefs about alcohol problems influence behaviour change processes. He is editor of www.alcoholpolicy.net and is a behaviour change trainer. He is on Twitter @jamesmorris24.