Mythbusters: All heavy drinkers are alcoholics

That guy who is notorious for getting legless at every social gathering might be called an alkie or an alcoholic behind his back. But the label is unlikely to be on the mark, at least not from a diagnostic point of view. New research from the United States has found that nine out of 10 heavy and binge drinkers are not dependent on alcohol and could potentially curb their drinking with a combination of effort and support.

The study, by the US Government’s Centers for Disease Control and Prevention, investigated the prevalence of alcohol dependence among 138,100 adult drinkers between 2009 and 2011 and found a relatively low level of addiction even for the biggest drinkers. Alcohol dependence was 10.2 percent among excessive drinkers and 10.5 percent among binge drinkers. The results counter the stereotype that everyone who regularly drinks to get drunk is an alcoholic.

The authors say their findings have important implications for public health measures to tackle problem drinking, since even the most excessive drinkers are unlikely to need drug dependency treatment. Strategies such as increasing tax on alcohol, regulating alcohol outlet density and increasing host liability could help reduce dangerous alcohol use.

For this study, ‘heavy drinking’ was defined as eight or more alcoholic drinks per week for women and 15 or more drinks per week for men. ‘Binge drinking’ for women was having four or more drinks in one sitting, and for men, five or more drinks in one sitting. Regardless of whether they meet the threshold for alcohol dependence, it’s clear many New Zealanders would recognise their own drinking habits fall into these undesirable categories.

Alcohol is our most commonly used recreational drug, and it’s a leading contributor to crime, disease and injury that is estimated to cause 800 deaths annually. Latest Ministry of Health figures (2011/2012) show one in five drinkers (19 percent) have “hazardous” drinking patterns – posing a risk to the drinker’s mental or physical health. This equates to about 532,000 New Zealanders. Men are much more likely to have risky drinking habits, at 26 percent, than women, at 12 percent.

The New Zealand Law Commission’s 2010 report Alcohol in our Lives: Curbing the Harm says national drinking surveys have consistently shown around 25 percent of drinkers – the equivalent of 700,000 Kiwis – typically consume large quantities of alcohol when they drink. Among young drinkers aged 15 to 24, the rate is much higher, with about half binge drinking in this way.

Professor Doug Sellman, Director of the National Addiction Centre at the Christchurch School of Medicine, is not at all surprised by the American research showing fairly low rates of alcohol dependency even for high-risk drinkers, but he says it comes down to definitions. The term ‘alcohol dependence’ has meant different things over time according to the diagnostic criteria being applied. In the latest handbook for psychiatric disorders, the new term is the much broader ‘alcohol use disorder’, but whatever the label, Professor Sellman says the underlying problem of excessive drinking remains the same.

“I think we have a similar profile to the United States. The issue is the extent of heavy drinking in both countries and virtually all other Western countries.”

A pattern of hazardous drinking is hard to break regardless of whether it has reached the point where drinking becomes compulsive and can be termed an addiction, he says.

“The more ingrained the addictive habit becomes, the more challenging it is for a person to recover from the disorder.”

It might be more helpful and more productive to reframe the debate over alcohol away from definitions of alcoholism. The word is freighted with misunderstanding and stigma, and it can put people off seeking treatment or taking steps to cut back their drinking because they’re reluctant to associate themselves with such a negative term. Lotta Dann, manager of the support website Living Sober, says the label ‘alcoholic’ can be a barrier, and for that reason, it doesn’t feature in any welcome messages on the site. Dann shot to prominence last year following the release of Mrs D is Going Without, which recounts her journey to quit drinking.

She says the website, launched six months ago, has gained 1,500 registered members and provides a safe forum for people to share their experiences and offer advice as they try to live without alcohol.

“The word ‘alcoholic’ is rarely mentioned at Living Sober. It is irrelevant to many of our members. We don’t spend a lot of time debating how to label ourselves. We all accept the truth that we struggle to control and moderate the drug of alcohol, but we don’t get hung up on semantics. We just cut to the chase of trying to not drink day in, day out.”

So, yes it’s a myth that all heavy drinkers are addicts or alcoholics, but that doesn’t mean they don’t have a problem with booze. The right question to ask, perhaps, is not “Am I an alcoholic?” but “Why am I drinking so much so often, and what can I do to stop?”