We’re always talking about alcohol abuse and dependence, and the difference between the two. They both suffer consequences because of their drinking, but alcoholics are physically dependent on the substance, and they experience withdrawal symptoms if they stop drinking. The American Psychiatric Association is considering categorizing alcohol abuse within a spectrum of disorders, which would classify some drinkers as “almost alcoholics.”
The grey areas of drinking
The lines are blurry between alcoholics, alcohol abusers and people on the brink of having these problems. An alcoholic may not show the same symptoms as other drinkers, or a “normal” social drinker may share in characteristics of an alcohol abuser — that’s why some people want diagnosis on a spectrum — to account for all the gray areas we see in real live people.
Staff at Harvard Medical School have been developing a book series that talks about almost alcoholics. “There is a tremendous number of people who have alcohol problems and almost all have gone through the gray area of the scale,” said Dr. Robert Doyle, a co-author and clinical instructor of psychiatry at Harvard Medical School. “So almost everyone who’s at the far end had some experience in the ‘almost’ range, and if we can bring some awareness to that, we might be able to help them make some health lifestyle changes.” (1)
Seeing the signs
Some physicians agree that being able to define someone as an almost alcoholic would be beneficial for early intervention. “It’s about describing symptoms that aren’t normal, that are well documented, and explaining those symptoms to people so they can better deal with them and have better health now and in the future,” Dr. Julie Silver, an assistant professor at Harvard Medical School said. (1) “It is good for people and their friends/relatives to recognize the signs and symptoms or alcohol abuse and addiction, so that they may be able to influence someone before they get into trouble,” said Dr. Robert Gwyther, professor in the department of family medicine at the University of North Carolina at Chapel Hill School of Medicine. (1)
Too many terms
Other physicians are concerned there’s already too much confusion, and adding “almost alcoholic” to the mix would just lead to more problems with diagnosing. “We run the risk of having too many terms — alcohol abuse, alcohol misuse, risky drinking, unhealthy use, almost alcoholic,” said Dr. James Garbutt, a professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine. (1)
At least this opens up the topic more, regardless of whether or not the almost alcoholic will stick.
“Alcoholism is a progressive disease and it is always precluded by problematic drinking behavior,” said Dr. Jason Hershberger, chief of psychiatry at SUNY Downstate Medical Center. “Problematic drinking is common, more common than full-blown alcoholism, and once identified, it can be helped.” (1)
Take Our Online Assessment
Take this Alcohol Addiction Assessment. The Michigan Alcohol Screening test (MAST), is a self-scoring test that helps determine whether an individual has a problem with drinking. (This is the current revised version of the MAST; the original MAST is composed of 25 questions and uses a more complex scoring method.)
Selzer ML: “The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument” Am J Psychiatry 127(12):1653-1658, 1971.
This test is only for ALCOHOL ABUSE. There is a separate test for Drug Abuse called DAST and can be accessed here.