Mind Matters with Kyle MacDonald: Alcohol addiction is complicated

Alcohol is a potentially addictive drug and for some, use can lead to significant dependence, which makes stopping difficult. Photo / 123rf

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Q: I've recently tried to stop my drinking, I don't drink every day, and sometimes I can control it and just have one or two drinks. But my GP has told me my health is suffering, and I need to cut back or stop, but I'm finding it hard. How do I know if I'm an alcoholic, and is alcoholism a disease? I don't really want to go to AA, but not sure what else to do.

A: When it comes to changing how we drink or use any drugs, it can be a wobbly old road, and it can also take time.

There are also many ways to skin the proverbial, and Alcoholics Anonymous is just one of them. The idea of alcoholism being a disease is rooted in AA - also called 12-step programmes - and needs some explaining, because it isn't a disease, and nor is "alcoholism" a concept or diagnosis we use clinically anymore.

At the risk of contradicting myself I'm also a big fan of AA, and often recommend clients struggling with their drinking use it alongside regular therapy.

Addiction is complicated. Alcohol is a potentially addictive drug and for some, use can lead to significant dependence, which makes stopping difficult. However, "alcoholism" as a disease is an outdated concept that may still hold meaning in everyday language but isn't a very helpful way to describe how people drink problematically.

We now recognise that alcohol and other drug problems fall into two broad categories, substance abuse, or substance dependence. Abuse recognises that people can drink in ways that may or may not be regularly but nonetheless lead to negative consequences in their lives and that some people drink regularly until they become dependent, have trouble stopping and experience cravings when they do.

Neither of these patterns is a disease. In fact, there's also little consistent evidence that developing problems with alcohol or drugs is in any way genetic - or hardwired - either. It seems tolerance for alcohol is genetic, and this may run in families in ways that make people more vulnerable to developing problems. But plenty of people with a high tolerance don't develop problems.

The concept of disease looks even shakier when we consider that 60-odd per cent of people who stop their problematic alcohol use do so without any support whatsoever.

Having said all of that, seeing alcohol problems as a disease can, for some, be a useful metaphor - or framework - for understanding their struggle to stop drinking. And in that way, it doesn't really matter if it's true or not, only that it's useful.

And for me, that's the truth about AA - if it works for you, then keep doing it. The research about its effectiveness varies, but all that really matters is it works for the people it works for.

Which is really just all a long-winded way of saying, feel free to give it a go. It may suit, it might not, but also know that there are other options if it doesn't.

From what you've said, it sounds like your pattern of drinking isn't full-blown dependence, but is certainly heavy enough to be causing you physical damage, and emotional concern. It's okay to try stopping without professional - or group - support, but also important that if you feel it's too hard you're able to reach out for support.

There are supportive alcohol-free social communities, online and offline, as well as helplines, face-to-face counselling, public and private - and of course AA.

But whatever you do, be prepared that stopping - or even just cutting down - is largely an emotional task. Whether we start drinking to deal with difficult feelings or lose the ability to tolerate strong feelings because of how we use alcohol, either way relearning how to tolerate and sit with emotions is a necessary part of the process.