This Naked Mind

To find a cure we must understand the problem. What causes the alcohol epidemic in society, the drinker or the drink? We will look carefully at each.

The Blame Game 1.0: Me

Who is to blame? It seems society would have you believe that it is you, the drinker. You probably believe that your inability to control drinking—unlike “regular” drinkers who can “take it or leave it”—is due to a flaw you possess and they don’t. What if that’s not true?

I bet when you drink more than you should or when you wake up with a hangover, you beat yourself up. I know I did. I would drink a bottle or more of wine each evening and fall asleep quickly. But I awoke at 3 a.m. when the carbohydrates and energy from the alcohol flooded my system. Every night, I lay there and chastised myself for overindulgence, vowing to be better tomorrow.

The next day seemed invariably long and tiring, and by late afternoon I craved my wine. When evening came, I pushed the vows I’d made to the back of my mind. Sound familiar? For you it may be a different drink, a different cycle. Perhaps your drinking is not quite as bad, or maybe it’s worse. The bottom line is that when we discover we are unable to control our alcohol, we blame ourselves. It’s easy to do. Society blames us; our families blame us; our friends look at us with pity, wondering why we can’t get our lives under control. We live in a state of constant self-loathing. What if it’s not your fault?

It is difficult to be drinking more than you would like. You start to hate yourself, feeling weak and out of control. If you hadn’t hid your problem so well more people would judge you, wondering why you can’t simply “get it together,” “be responsible,” and “take control.” After all, they drink but don’t seem to have a problem.

If you are like most problem drinkers, you interpret your inability to control your drinking as weak willpower or a personality flaw. If only you had more willpower, you could drink less or abstain. If only you could quit for some unknown length of time, your desire for alcohol would diminish. You would finally be like all the people you know who seem to be in control of their alcohol, who seem to be able to take it or leave it. But wait. Are you weak-willed in other areas of your life or is alcohol a strange exception? I am distinctly not weak-willed, as people who know me can attest. Isn’t it strange that I seem to lack willpower in this area?

Does it make any sense that alcoholics—those who need to control their drinking most—are the same people unable to do so? Why can’t they simply exercise their free will and stop? Is there something, apparently undiagnosable, that makes certain people less able to control their alcohol consumption than others?

Am I an Alcoholic?

So what is an alcoholic? And how do I know if I am one? The majority of adults drink. According to the National Institute on Alcohol Abuse and Alcoholism, a whopping 87% of adult Americans drink.

What differentiates the casual drinker, the moderate drinker, the heavy drinker, the problem drinker, and the full-blown alcoholic?

According to Paying the Tab by Philip J. Cook, if you drink a single glass of wine each night you’re in the top 30% of all drinkers. If it’s two glasses, you’re in the top 20%.

That means that 80% of adults drink less than you. But many people who imbibe a glass or two of wine with dinner do not fit the stereotypical description of an alcoholic. Alcoholism isn’t strictly defined by how much or how often you drink. There is an invisible and ill-defined line that categorizes the “true alcoholic.” Since the line is arbitrary, and alcoholism does not have a standard definition, how are you supposed to know if you actually have a problem?

A quick Google search reveals dozens of test questions intended to answer the question, “Am I an alcoholic?” They all carry a disclaimer saying they cannot provide a diagnosis for alcoholism. They say that is a decision I have to make.

How is it that the majority of Americans drink, yet for a self-diagnosed select few, a fun, social pastime turns into a dark, destructive secret? And why then do we deny the problem and put off asking for help as long as possible, until the problem becomes truly unmanageable?

It’s quite easy for us to self-diagnose as “non-alcoholics” when we start to think we have a problem. Most people believe that alcoholics are somehow different from other people, different from “us.” Many assume that alcoholism results from some type of defect. We’re not sure if the defect is physical, mental, or emotional, but we’re sure that “they” (alcoholics) are not like “us” (regular drinkers).

Jason Vale explains that most doctors belong to the “state the obvious” brigade. They pronounce something like: “You are drinking a lot, and it is starting to affect your health. My recommendation is that you moderate or stop drinking.”

Then the doctor goes on to say that only you can decide if you are an alcoholic. Really? I might have a fatal illness, but no one can diagnose me? As a drinker, the suspicion that I have a serious problem will likely cause me to drink more. And why not? We believe alcohol relieves stress, and the journey to overcome denial, put away my pride, and determine if I am an alcoholic is terribly stressful.

If there is a specific physical or mental attribute responsible for alcoholism, why can’t we test for it and segment the population into alcoholics and regular drinkers? That would enable us to prevent the afflicted individuals from falling victim to drink. If there is something inherently different about alcoholics, surely we could find some indication of it before they harm themselves, their family, and society as a whole.

With good reason, we applaud the strides scientists have made in medicine. Amputees with prosthetic limbs can now control the prosthetics’ movements with their thoughts, which are translated to the limb by electrical signals from the brain.

Dr. Sergio Canavero, an Italy-based neuroscientist, is preparing to transplant a human head.

Recent advances in medicine blow our minds. If there is a specific physical or mental defect responsible for alcoholism, I find it hard to believe that we can’t, in this day and age, diagnose and prevent it.

Am I saying every person responds the same way to alcohol, no matter their genetic or physical disposition? Not at all. Like the way one glass of wine affects two people differently, long-term exposure to alcohol has different effects on each of us. I am not debating this. Nor am I saying there is no evidence for a gene that increases a proclivity for alcohol addiction. We have discovered many loose relationships between genes and alcohol use but none definitive enough to declare responsible.

The genetics lab at the University of Utah, a department that studies the role of genes in addiction, says that someone’s genetic makeup will never doom them to becoming an addict.

Polk confirms that, despite any genetic connections, someone cannot become an alcoholic without repeatedly drinking alcohol.

It seems strange to use the term “alcoholic.” We don’t have cigarette-o-holics but rather people who have smoked and therefore become addicted to cigarettes. Similarly, you don’t hear about people who are cocaine addicts suffering from cocainism.

If you consider yourself a regular drinker, you probably take issue with this sentiment. Why? Because if we agree that no specific, diagnosable physical defect separates alcoholics from the population of “responsible” drinkers, everyone who drinks is susceptible and perhaps on the path to alcohol dependence. I assert that over time, with the right level of exposure, anyone can develop a physical dependence on alcohol. And since we are all built differently, no one can determine at what point an individual will develop dependence. This message isn’t popular; it flies in the face of our thriving alcohol industry, our societal dependence on the drug, and the attitudes of “regular” and “responsible” drinkers who pride themselves on maintaining control.

The Blame Game 2.0: A.A. and the Alcohol Allergy Theory

I used to accept the notion that alcoholics were different than regular drinkers. Why not? The alcoholics I knew said they had a disorder or defect, so who was I to argue? Since that time I have done a tremendous amount of research. It took me some time to find out where the belief started and why it was accepted. I discovered at once how genetics play into the diagnosis. Neuroscientist Thad Polk says, “There is no single addiction gene; dozens of genes have been identified that affect addiction susceptibility, and most of them only have a small effect by themselves.”

We have not yet found a way to diagnose or prevent addiction based on genetics.

Understanding why alcoholics themselves believe they are different from the normal population proves more difficult.

We accept this theory for a handful of simple reasons. Regular drinkers like it because it allows them to believe they are in control— safe to continue drinking without any worry that they will cross the arbitrary line into alcoholism. Alcoholics like the theory because once you “come out” as an alcoholic, your friends make an effort to help you abstain, rather than pressuring you to drink. They mix you mocktails and support your journey to fight the disease. It is easier to abstain when no one offers you alcohol. Also, physical difference means you receive less blame. We don’t blame people who get cancer; disease allows for forgiveness. Finally, it is easier to maintain sobriety if you believe one slip will bring a fatal disease out of remission.

A.A. is the world’s most prolific approach to treating alcoholism, with more than two million members in 175 countries.

Let’s examine A.A.’s approach to alcoholism to understand what assumptions we, as a society, have made and how these assumptions translate into beliefs about alcoholism. A.A.’s primary documentation is informally called “The Big Book.” Its official title is Alcoholics Anonymous, the Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. This book describes Dr. William D. Silkworth, who treated but did not cure Bill Wilson, founder of A.A. Dr. Silkworth specialized in treatment of alcoholism, and in 1934 he unsuccessfully treated a patient who he concluded was hopeless. When A.A. later cured this patient, Dr. Silkworth wrote this letter to Bill Wilson:

We doctors have realized for a long time that some form of moral psychology was of urgent importance to alcoholics, but its application presented difficulties beyond our conception. What with our ultra-modern standards, our scientific approach to everything, we are perhaps not well equipped to apply the powers of good that lie outside of our synthetic knowledge.34

Here, Dr. Silkworth recognizes that the solutions A.A. forwarded are successful beyond what the medical profession was able to offer. And the “ultra-modern” medicine of 1939 is still in use today.

The letter goes on to speak about how, where medical procedures fell short, the “unselfishness and community spirit of recovered A.A. members, who want to help those afflicted, has been an astounding success.”

I will quote the most important part of the letter directly:

We believe . . . that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class [of people] and never occurs in the average temperate drinkers. These allergic types can never safely use alcohol in any form at all; and once having formed the habit [they have] found they cannot break it, once having lost their self.36

The letter discusses the inadequacy the doctor feels in helping these alcoholics and that he is astounded to see how a psychological change—like inclusion in A.A.—allows alcoholics to heal. You may notice this letter contains a contradiction. How can alcohol be an allergen that is only activated once the habit is formed? It seems to indicate they believe alcohol to be a manifestation of an allergy but that they also must “form the habit” for that allergy to manifest. It makes more sense to believe that alcohol is an addictive substance to which any human can become addicted once enough is consumed.

The idea that alcoholics differ physically from the rest of us was hypothesized without any corroboratory lab findings by a doctor who suspected some people suffered from an allergy to alcohol. Allergens are relatively easy to diagnose, and 76 years later we have not found an allergy to be responsible for the disease of alcoholism. But Dr. Silkworth needed an explanation for A.A.’s success in helping alcoholics for whom medical prowess failed.

How did this belief, that a physical flaw differentiates regular drinkers from alcoholics, become so widely held? A.A.’s response to Dr. Silkworth’s theory is telling:

In this statement he [Dr. Silkworth] confirms what we who have suffered alcoholic torture must believe—that the body of the alcoholic is quite as abnormal as his mind. It did not satisfy us to be told that we could not control our drinking just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact to a considerable extent with some of us. But we are sure that our bodies were sickened as well. In our belief, any picture of the alcoholic which leaves out this physical factor is incomplete.37

What a relief the pioneers of A.A. must have felt. It is wretched to feel that your mind is not strong enough to resist alcohol. How much better to believe something is wrong with your body, something out of your control. A physical flaw, in a sense, lets us off the hook for our inability to maintain control when drinking. The A.A. literature of today continues to perpetuate the theory that alcohol is an allergen. A booklet that is distributed at today’s meetings states,

As far as we are concerned, alcoholism is an illness, a progressive illness which can never be ‘cured,’ but which, like some other illnesses, can be arrested . . . We are perfectly willing to admit that we are allergic to alcohol and that it is simply common sense to stay away from the source of our allergy.38

“Us” and “Them”

While A.A. saves many from alcoholism, I must point out the danger of the physical-flaw theory. Given the widespread drinking in our society, this theory can be dangerous. We continue drinking unchecked, often overlooking the danger of addiction, because we have come to believe alcoholism can only happen to other people. By the time we realize we have a problem, we are faced with self-diagnosing a fatal and incurable illness or admitting to being weak-willed and lacking self-control. We tend to avoid this horrific diagnosis until things have gotten so out of control we can no longer avoid the problem. In some ways this approach has defined alcoholism as a disease of denial. It is standard practice for drinkers to hit rock bottom before they seek help. When I told a friend I had stopped drinking, her immediate response was, “I can’t imagine what you must have been through in order to make that decision.” The assumption was clear: I must have had a rock-bottom experience.

We see this physical-flaw theory play out in every A.A. meeting. The meeting starts with a round-robin of, “Hello, my name is ______, and I am an alcoholic.” By forcing me to name the problem—I am an alcoholic, a person with a physical flaw that gives alcohol unreasonable control over me—they make the affliction easier to deal with. Members of A.A. enjoy the fellowship of like-minded people fighting a similar battle, and through that community and support they find sobriety. But how does this physical-flaw theory affect drinkers who don’t (or won’t) consider the possibility that they have an incurable illness? Those who don’t (or won’t) consider themselves alcoholics?

Instead of treating alcohol with caution because we know it to be dangerous and addictive, we reassure ourselves that we are different from those flawed people we know as alcoholics. I speak from experience. And no one treats this as an insult. The alcoholics themselves confirm they are “different” from the normal population. So, millions of “regular” drinkers go through their drinking lives with no fear that they might become alcoholics.

We also believe that addiction to alcohol varies from other addictions because the rate of addiction happens differently for each person. We see many people who seem to “control” their drinking and can “take it or leave it.” So it’s difficult to understand why some people’s first sips launch them into full-blown dependence while others never reach that point. But it is not just alcoholics who systematically increase the amount they drink. Regular drinkers start off with just a few drinks and are soon consuming a nightly glass of wine. In fact, alcoholics start off as “regular” drinkers. In many cases it takes years for them to cross the indistinct line into alcoholism.