The first step toward recovery

September 09, 1992

Over the last 20 years, definitions of alcoholism have gradually evolved from the view that problem drinkers suffer from a character defect toward one that sees alcohol abuse as a medical disorder subject to treatment. The struggles of prominent people to overcome their debilitating addiction -- from former First Lady Betty Ford to the late Texas Sen. John Tower -- have been widely publicized.

Yet alcoholism remains one of the most difficult diseases to treat. By the time it is diagnosed, many alcoholics have become so adept at denying they have a problem that it is almost impossible for them to seek help.

Indeed, people who work with alcoholics frequently remark that treatment cannot begin until the abuser acknowledges that he or she has a problem. So powerful is the denial mechanism that even Alcoholics Anonymous used to assume that "you have to hit rock bottom before you can get better."

As a practical matter, that judgment is nearly always well-founded. The problem lies in the enormous human waste -- in shattered families, lost opportunities and blasted hopes -- that occurs while the alcoholic flails toward the bottom.

That is why the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine are now revising the standard definition of alcoholism, which focused on alcoholism's physiological aspects -- physical dependency, withdrawal symptoms and organ damage. Instead, they put greater emphasis on behavioral aspects of the disease, particularly the distorted thinking that produces denial. The hope is that the new definition will help the families, friends, co-workers and physicians of alcoholics to recognize symptoms more quickly and speed intervention.

Alcohol abuse remains a major killer: Nationally, more than 10 million Americans are afflicted with the disorder. Last year there were some 300,000 alcohol-related deaths -- 10 times the number of deaths attributed to drug use. Alcohol is the nation's No. 1 substance abuse problem. And the nation pays a heavy price for it -- in police protection, jails, drunk-driving accidents, spouse and child abuse.

Changing the wording of a definition in medical textbooks won't make the problem go away. But it will be counted as progress if it helps more people overcome their denial and seek help -- before they kill themselves or someone else in a car crash or suffer irreparable liver damage.

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