Many different terms have been used somewhat loosely to describe behaviors that, on the surface, may appear to belong to the same condition. Actually, some of those labels are synonymous while others are not. Terms such as alcoholism, addiction, and chemical dependency all describe a condition that differs from the one described by terms such as abuse, or getting drunk or high. In an attempt to avoid confusion, we will use 3 terms to describe 3 distinctly different conditions. Those are Use, Abuse, and Chemical Dependency, or simply CD:
Use = normal drinking, social drinking
Abuse = getting drunk or high
Chemical Dependency (CD) = addiction, alcoholism
Although these conditions share some characteristics, they differ in several important ways:
|1. Description||"Social" drinking||Sometimes drinks or uses inappropriately||Addiction, Alcoholism|
|2. Adverse consequences||None||Some||More|
|3. Ability to control use||Not needed||Yes - Changes behavior when faced with adverse consequences||No- Loss of control & continued use despite adverse consequences. Compulsive|
|4. Other||Denial, minimization, rationalization, projection. Disease process at work!|
For a variety of reasons, many people have simply chosen never to drink or drug. For them the chart and problems above are not relevant, except perhaps to explain the behavior of a friend or loved one.
Many people use or have used alcohol or drugs, and they do so without any adverse consequences. There is no more need to "control" their use of alcohol than there is to control their use of asparagus. It simply is not a problem to them. In fact, someone who professes to control his or her drinking or using has probably moved beyond simple use.
The journey from use to abuse is generally a reversible one. It is the limit of experience for the 85% of the population who, due to the fortunes of genetics among other things, will never face the loss of control that comes with chemical dependency. Abusers are people who may have partied in college, gotten drunk or high a few times, maybe gotten sick, and perhaps embarrassed themselves a time or two by something they did while drinking or drugging. Such people will "learn" from the consequences of their actions, and simply choose to not drink and drive again, or to limit themselves to 1 or 2 drinks, or not drink again; to moderate their behavior some other way. The most important thing is that they are able to consistently keep those promises to themselves. For them, using or drinking is still a controlled behavior.
For those less fortunate, who may have inherited such anomalies as a deficiencies in certain types of neurotransmitters or receptor sites or reuptake ports, alcohol and drugs are metabolized differently. Dr Darryl Inaba's book "Uppers, Downers, All Arounders" provides an excellent discussion of the physiology of addiction, and why CD has been recognized as a disease these past several decades by the American Medical Association, the American Dental Association, and other professions.
The point is, once the line is crossed between abuse and chemical dependency, there is no going back. Once addiction has manifested, it cannot be reversed, and "normal" drinking is no longer possible. The hallmarks of addiction listed in the table above forever await the recovering chemically dependent person who does not vigilantly maintain sobriety.
The American Society of Addiction Medicine provides a much more thorough definition of alcoholism. That definition works well to describe chemical dependency when "alcohol and other drugs" is substituted for "alcohol." In part, it says:
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. Each of these symptoms may be continuous or periodic.
Abuse is a behavior, and it can be prevented. Chemical dependency is a disease, and it can be treated. The difference is important. A "normal" person who is abusing alcohol or other drugs can respond to education and willpower. Such a person can "just say no." However, someone who is chemically dependent can no more "just say no" to drinking or using than someone with diabetes can will changes in his or her blood sugar level, or someone with diarrhea can just not go to the bathroom. Sorry to be so graphic, but the point is important and commonly misunderstood.
When used to describe chemical dependency, the word "denial" really means something more like delusion. Denial as it is commonly used implies conscious lying or misleading. While an active addict may be doing that too, the CD meaning of denial refers to a type of self-deception. When a person is convinced of an falsehood, he or she may not even be aware of lying while trying to convince others that the falsehood is true. Such denial of denying is typical of the multiple layers of deception commonly seen in a chemically dependent person. The ASAM definition of alcoholism states that denial is "...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."
Also feeding denial is the long history of failed attempts to control use that most active alcoholics or addicts have accumulated over drinking or using careers. They don't know that chemical dependency is a disease and that it cannot be successfully addressed by willpower alone, but that it can be treated successfully in other ways. They just know that for some reason they are unable to control it. To acknowledge they have a problem that they've proven repeatedly they cannot solve is beyond the psychological ability of many people to accept.
What "clues" does someone afflicted with the disease of chemical dependency give to a staff member, colleague, friend, or spouse? The following list is not meant to comprise a diagnosis. Rather it summarizes many of the "red flags" that could indicate chemical dependency. Some are obvious:
Other signs are more subtle: