“I see myself in a gray area,” says Ian. “Alcohol caused me problems, so, sure, I had a problem. I was binge drinking a lot—I hit double figures [for drinks] at least one night every weekend. It was bad for me physically, I got in fights, did and said stupid things, damaged relationships and some days missed work.”
From its peak between the ages of 21 and 25, the Brooklyn sales professional, now 30, found that his drinking declined. “There isn’t one point where I could say it happened; it just became rarer for me to get seriously drunk.” In the last three years, he says, “the worst consequence I had was some headaches. Alcohol is still a big part of my social life; it’s a positive, fun experience. I just don’t go crazy anymore.”
So what happened to him? Is he or isn’t he an alcoholic? He credits the change in his life mainly to external circumstances that “made me want to get wasted less,” such as an improvement in job prospects, some different friends and “just growing up a little, I guess. I’m happier now, and that means you don’t drink the same way.” As for a problem-free future, “I don’t know for sure. I just feel I have a good chance.”
“I’d wager no drinker could read this list and not answer yes to at least one question. Is everyone an alcoholic?”
It’s not rare to hear stories like Ian’s. But people like him are at the center of a raging debate this year. Should addiction retain discrete diagnoses—like the American Psychiatric Association’s “alcohol abuse” and “alcohol dependence,” or AA’s “alcoholic” and “normie”? Or can substance problems more accurately be placed on a spectrum that would overturn generations of conventional views of addiction as an either/or proposition?
This idea pokes at wasps’ nests within both the psychiatric community and the recovery community, where 12-step literature and traditions revolve around definitive self-identification as an alcoholic or addict.
In March, two publications added fuel to the firestorm. First came a survey from the Partnership at Drugfree.org and the New York State Office of Alcoholism and Substance Abuse Services. It found that 10% of Americans aged 18 and up answer “yes” to the question, “Did you once have a problem with drugs or alcohol, but no longer do?”
So an estimated 23 million US adults put themselves in the category of “had-a-substance-problem-but-don’t-now.” There’s nothing controversial in that. But it begs the question of who they all are. Most aren’t in 12-step or alternative programs—AA, easily the largest such fellowship or group, puts its US membership at just under 1.3 million. While a third of US adults don’t drink, does “no longer having a problem” mean total abstinence in every case?
Anecdotal evidence suggests that plenty of those who’d answer yes to the question aren’t sober. These people might interest authors Robert Doyle and Joseph Nowinski—a clinical psychologist and a clinical instructor in psychiatry respectively. Their book, Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem? was also published last month. “The almost alcoholic zone is actually quite large,” they wrote in The Atlantic. “The people who occupy it are not alcoholics. Rather, they are men and women whose drinking habits range from barely qualifying as almost alcoholics to those whose drinking borders on abuse.”
Their intervention comes in the context of the American Psychiatric Association’s apparent consideration of “a paradigm shift in the way we view mental illness, including substance use” for inclusion in the next edition of its powerful Diagnostic and Statistical Manual, potentially moving towards Doyle and Nowinski’s belief that “some conditions might be better thought of as existing on a spectrum rather than in terms of discrete categories such as alcohol abuse and dependence.”
This “might be viewed by some as opening the door to over-diagnosing the associated problems,” they argue. “We believe the opposite will prove to be the case: that this paradigm shift will allow people to recognize problems earlier and to seek solutions without having to be labeled as alcoholics.”
So who are the people who say they’ve had a problem in the past, yet don’t practice abstinence—and who might populate the middle reaches of a spectrum view of addiction? And how do they define themselves?
Mark, 35, a producer from London, moved temporarily to another city eight years ago, where he had a hard time and found that his drinking began to get out of control, “culminating in a need to drink in order to feel normal. I found myself drinking every day, and eventually every day from morning till night. Obviously at this point both my social life and professional life were heavily affected.” He would also put himself and others in danger: “I would spend whatever money I had and risk driving just to find more alcohol.”
These problems lasted several years. But without professional or group support, he started cutting down significantly about five years ago. “I drink so much less,” he says now. “My working life has not been interrupted by drinking in a long time.” He describes his current drinking habits as “essentially miniature versions of how they were; I still drink socially, on occasion to excess, and I still drink alone maybe once or twice per week.” However, “Now drinking alone will rarely if ever exceed two drinks.”
Why the change? “I engaged with it and took control of the situation,” he says. He also cites “an emotional attachment that no longer exists” as partly to thank. “Key elements for me are my ability to moderate, and maybe more importantly my desire to moderate.” He does admit, “I occasionally get the sense that I’m vulnerable to veering back into drinking too much. When I feel that, I keep a check on the situation and make sure I’m disciplined.”
Ian says that while joining AA never really occurred to him, “If I’d met the right people when my problems were bad, I could easily have been convinced to join. But I’m relieved now that it didn’t happen.” Mark did consider AA during his toughest period, but “decided that abstinence wasn’t the way for me. I’m sure it’s the correct route for some and can be successful and necessary…but I find the idea of abstinence being the only path restrictive and potentially damaging.” He argues, “For me, I think that way of thinking would have led to a situation where a life controlled by drink would have simply been replaced by a life controlled by not having a drink.”
Storylines like those of Ian, Mark and the other sources in this article can expect a skeptical reception in 12-step circles. The view there that being an alcoholic or an addict should be self-identified gives us one set of answers: none of our sources identify as such.
On the other hand, our group has a more problematic relationship with the Twenty Questions to self-diagnose alcoholism that are widely distributed within the fellowship—with the guideline that answering “yes” to three or more either means you “may be” an alcoholic or that you’re “definitely” an alcoholic, depending on where you read them. Our five sources all answer “yes” to between three and seven of these questions, and are likely to be seen simply as alcoholics and addicts in denial by many in the recovery community.
That said, it doesn’t take much imagination to apply affirmative answers to three of the questions—“Have you ever felt remorse after drinking?”; “Do you drink alone?” and “Have you ever had a complete loss of memory as a result of your drinking?”—to a light drinker whose only booze problem consisted of an isolated, youthful indiscretion.
Lee, a 30-year-old writer from Brooklyn, makes this point: “I’d wager no drinker could read this list and not answer yes to at least one question. Is everyone an alcoholic?” A current drinker, he formerly had a problem with heroin and opiate painkillers.
Lee claims drinking itself was never his issue: “My problem was with one specific type of narcotic. Other drugs [like cocaine] and alcohol never took hold of my life in the same way. Drinking never interfered with my life in a lasting way.”
But he explains, “When I was a kid I was reckless and self-destructive whenever I drank…I always did hard drugs in tandem.” Following an unsuccessful 12-step experience and a stint in rehab, he now hasn’t used opiates for eight years.
He still admits, “I do drink too much…but I don’t see it as a problem if it doesn’t adversely affect your health, relationships or work.” Apart from “a few sexually-charged drunken arguments with my wife [when both are drunk together],” he claims, “I can safely say this isn’t the case for me. My days of getting in bar brawls, sleeping in alleyways, and blacking out are long over.” Describing the idea of total abstinence from all drugs for someone like him as “bullshit,” he credits learning self-control through cognitive conditioning for his better life today.
“I’m about a seven, somewhere between the average and the most addictive personality.”
Jen also had a drug problem that she finds is no longer a problem. But the 34-year-old Manhattan-based accountant not only drinks socially these days; she also occasionally uses her previous problem drug—cocaine—without noticeable ill-effects.
She got seriously into coke soon after leaving college. “I was doing it at least three times a week for about a year,” she recalls. “I’d be home on the couch with my roommate, and we’d sit up all night doing it. To begin with it was just a little, then we’d do a gram or more per night.” She feels it happened because “I was depressed, bored and it was the only way I found I could somehow ‘pause’ in my life at that time.” She was having trouble finding permanent employment, and drifting between temporary jobs.
“It became this thing where when I was on coke I felt like I understood everything and was at peace with everything,” she says. “I actually felt I was smarter!” But after a while this feeling changed to one in which “I couldn’t get enough and it was like this terrible itch. After my roommate went to bed I’d scrape through the empty bags. I used to hide stashes for when I ran out. Sometimes I hid it too well, then I’d go crazy when I couldn’t find it!”
One morning she went to work after an all-night session. “I was shaking and sweating so badly I told them I was sick and went home.” That prompted her to tell her roommate, “’I need to stop. I can’t control myself. If you’re ordering, don’t tell me.’ And she was good enough to do that.” She also told other friends that she had a problem, and asked them not to take the drug when she was around, although she carried on drinking socially.
About five years later, Jen met a group of people who use cocaine socially while out drinking. She joined in and enjoyed it. “Weirdly, I found drinking at the same time helped me control it,” she says. “I was more aware of [the potential for problems] and kept it ‘recreational’—only at the weekends.” Since then, she’s used coke “every few months, but less and less. The last time was over six months ago.” Asked how she thinks she’s been able to do this, she shrugs: “Life changes, you slow down. I’m just older now.”
“I think I was an addict. But I don’t think I am now,” she says. “I know that won’t make sense to some people. But that’s how I feel. I just don’t crave it now.” On an addiction spectrum, she’d place herself “about a seven, somewhere between the average and the most addictive personality.”
As befits such a shakily-defined group, some potential members doubt whether they really belong to it, and whether such a thing really exists. “I’m not sure there is a ‘gray zone,’” says Keith, a 41-year-old editor who lives in Connecticut. And asked about no longer having a problem with alcohol and drugs, he admits, “I would not quite say that I don’t. I would say I’ve just found a way to tamp it down.”
Back in his college days, “some blacking out and stupid behavior—fights, vandalism—kicked in.” That’s when he “figured I was basically defective with regard to what other people called ‘partying.’ Later on in college I ingested unusual amounts of hallucinogenics. Those are still largely happy memories.”
For over a decade after leaving college, Keith took copious amounts of ecstasy, marijuana, “oceans of booze” and cocaine. “My ‘social’ life was almost completely centered around substances,” he says, adding that intoxication helped him to conquer his shyness. “During this same period, my favorite alone-time activity was to snort a modest amount of heroin and lie in bed.”
In recent years, he’s cut down, due to “sort of an uneasy truce, on account of my wife and children.” This takes the form of “occasional pot-smoking, though I no longer keep a stash,” and “no more ‘real’ drugs for a while now.” His alcohol intake, meanwhile, is regulated by “regular drinking punctuated by periods of abstinence… I know, I know.”
Although Keith says that for him to be “truly impaired” is “very occasional,” he’s seriously contemplating sobriety. “I read something the other day in a novel that floored me: ‘He must stop. At his age, he either had to join the resistance or become a collaborator with death.’ I sort of consider that I inevitably have to stop.”
Proponents of abstinence, Moderation Management, SMART Recovery and the rest won’t stop arguing about the interpretation of these kinds of experiences any time soon, and neither will the psychiatrists.
Are people like Ian just addicts whose problems will inevitably come back to bite them? Or does the self-management of problems like Mark’s just show that such people were never “real” addicts in the first place? Can substance problems be compartmentalized as Lee has found? Can being an “addict” be a temporary state, as Jen’s experiences have led her to believe? Or is Keith arriving at a resolution that all of them would do well to follow?
Not every different answer is mutually exclusive. A decision by the American Psychiatric Association to reclassify addiction as a spectrum, for example, wouldn’t damage any practical validity of an addict/normie dichotomy that 12-steppers believe vitally clarifies things for people in desperate need—although it would raise the volume of external criticism. But in an emotionally-charged debate, it’s worth remembering that many people don’t fit easily into categories—however carefully the borders are drawn—and that the nature of any help required may be as nuanced as the people requiring it.