How do you distinguish alcoholism from alcohol abuse?
As an alcoholic myself, the terms have always meant the same thing to me.
As an alcoholic myself, the terms have always meant the same thing to me.
There are plenty of people who will drink every day of their life in a way that evidences dependence, but with little or no evidence of abuse. I've had some of these in my family. They drank at the same time in the evening and in the same quantity every day for decades, and they were likely in some state of mild chemical dependence, but the addiction, as it were, never caused any trouble whatsoever.
It's not useful to call these people alcoholics.
Likewise, it would be absurd to label people who drink coffee or tea daily with "caffeinism", even if physical dependence is present. And we don't label people who are chemically dependent on anti-depressants with "SSRI-ism".
In my mind, attaching an "ism" to a substance is only useful to identify pathology, which doesn't necessarily have anything to do with dependence.
> It's not useful to call these people alcoholics.
Whether it's useful is not the point, especially whether it's useful to you personally. Alcoholism has a definition, which revolves around dependence. If they're dependent they're alcoholics, and it's still different than non-dependent binge drinking. You're basically trying to make the same distinction I just did (contrary to your own "they're the same" from two posts earlier), except that that you're using the term "alcoholism" for the wrong side of the distinction.
> In my mind, attaching an "ism" to a substance is only useful to identify pathology
You're using "pathology" in a very idiosyncratic way, almost opposite to its real meaning. To a clinician, social effects are not pathology. The pathology is the causes and effects on the individual, so dependence qualifies but wrecking your car doesn't.
Not... really.
The problem here is that the term "alcoholism" is a colloquialism, not a technical term. Neither the DSM nor ICD uses it. So I suppose it can mean whatever you want, but it would be good for the common usage of the term to be useful in some way, and indeed it is in this case. In everyday language, the term alcoholism overwhelmingly connotes problem drinking. I'm quite steeped in the culture for personal reasons, and I've never in my entire life heard anyone use the word "alcoholism" to refer to completely harmless and controlled consumption.
> contrary to your own "they're the same" from two posts earlier
No, I asserted that alcoholism, in its everyday colloquial sense, connotes abuse. I definitely do not assert the same regarding the notion of "dependence", which does have a widely used technical definition.
If it's dependence that we're debating, I'll argue that mere dependence on alcohol should not qualify it for the "alcoholism" label in the common pejorative sense. If you disagree, then I really am curious why you would not likewise label daily coffee drinkers with "caffeinism"?
In the other direction, I assert that any regular, pathological pattern of consumption indicates a degree of dependence, but I recognize that there's some semantic debate there.
> You're using "pathology" in a very idiosyncratic way, almost opposite to its real meaning. To a clinician, social effects are not pathology.
We're not talking about oncology here. Alcoholism is not diagnosed, treated, studied, or managed quite like a medical condition such as cancer or diabetes. Outside the world of medical doctors, the term "pathology" is usually truer to its greek root "pathos". "Pathologic behaviour", "pathological gambling", etc.
For what it's worth, the DSM and ICD largely classify mental disorders based on behavioural evidence. This is certainly true for alcohol dependence and abuse (DSM-IV) and alcohol use disorder (DSM-V).
In https://news.ycombinator.com/item?id=26763944 you used the exact words "meant the same". Don't retcon.
> Alcoholism is not diagnosed, treated, studied, or managed quite like a medical condition
Don't throw around terms like "pathology" then. If you have moral opinions about other people's drinking, just say so.
> DSM and ICD largely classify mental disorders based on behavioural evidence
"Behavioral" does not mean only effect on others. The distinction you're trying to make keeps shifting around, but AFAICT it hasn't at any point matched any common one.
That's right. I assert that the term "alcoholism" is most widely and commonly used to denote "alcohol abuse". That's what I said before and that's what I'm saying now. I'll say it again if you'd like :)
And again, I have never in my life heard a pattern of harmless and controlled consumption of alcohol referred to as "alcoholism".
Regarding the notion of dependence, I assert that (1) there is such a thing as alcohol dependency that does not result in or qualify as alcohol abuse, and (2) that in practice all alcohol abuse involves some degree of chemical or psychological dependence. I understand there is semantic debate about this, especially among cognitive scientists, and I'm comfortable taking a side. In DSM-IV, dependence and abuse are diagnosed by completely separate criteria. In DSM-V the criteria are merged under the diagnosis of "Alcohol Use Disorder".
Regarding binge drinking, I'll argue that all regular binge drinking should be considered disordered or abusive. Both DSM-IV and DSM-V guidelines appear to allow some amount of binge drinking to escape a clinical diagnosis, but in my experience regular binge drinking is always abusive in the ways that matter. I bet you every addiction counsellor you'll ever meet will agree with me on that.
> Don't throw around terms like "pathology" then.
Like I said, the word pathology is widely used with a broader meaning outside of hospitals and doctor's offices. But if you're really intent on policing that particular word, I invite you to take up the debate up with a clinical psychologist. Tell them that they're using that word all wrong, and they should use it only the way MD's do. Let me know how that goes.
> If you have moral opinions about other people's drinking, just say so.
No, I have no problem with alcohol, and I'm regularly around quite a bit of drinking. I have no problem making a run to the liquor store for dinner or a party, and I'm always glad to be the designated driver.
My experience leads me to believe that addiction is a disease, not a moral failure. I have the disease of alcoholism, a disease that is diagnosed clinically on the basis of my behavior. Not on my genes or brain structure, but on my behavior. I will never be "cured" of this disease. The best I can hope for is remission, and that's why I can never touch alcohol again, not even a single drink. But that's just my approach. I know there are others, and I don't judge them.
So this would seem to support my assertion that an "ism" generally denotes excessive consumption leading to "problems" by whatever definition one chooses.
I've used a month's worth of scare quotes today.
Alcoholism a behavioral health condition which inclines one toward unhealthy alcohol use.
Alcohol abuse is a behavior which can exist with or without that underlying condition.
A person can regularly binge drink, but not be dependant on alcohol.
Even if you could arrange a definition of dependence such that it doesn't apply to a regular problem drinker, then I think the term loses it's utility. The physiology and psychology of dependence is an interesting topic, but the disease of substance abuse IS the problematic behavior.
EDIT: I had to clean this up a bunch, apologies for the butchered first attempt.