The Elephant in the Room: Alcoholism

Let’s talk about alcoholism.

It’s college, we joke about it: “It’s not alcoholism until you graduate.” I’ve heard it a hundred times, and I’ve definitely said it. But when we make light of something enough—too much—we risk making someone suffering from substance abuse think it’s no big deal. We may even deter someone from seeking help by making their behavior seem like part of some bizarre, accepted norm. 

Alcohol abuse is a huge issue on college campuses, and I hardly need to mention that binge drinking is a major contributing factor. Scary terms have become a part of our everyday vocabulary—just last year Turner House’s then-president Abby Peoples, also a campus health adviser, urged the house to stop using the term “blackout.” She explained, “I remember hearing older students use the word blackout and tell stories that normalized this memory loss, even made it seem funny and cool. But being blackout is not normal, funny, or cool. It's dangerous on so many levels. It's a symptom of overdosing on a drug, and we often forget alcohol is a drug.” By de-normalizing that part of drinking culture, she hoped to curb the notion that blacking out is a normal part of life, rather than a red flag. (As a side note, Turner was hugely in support of this suggestion.) 

The default answer for alcoholism tends to be Alcoholics Anonymous. The program has come under heavy criticism in the past few years, but I’d like to defend its merits. 

As Doug Toft explains in a 2000 defense of AA: “Charlie Bishop, coauthor of To Be Continued: The Alcoholics Anonymous World Biography 1935-1994, 1 argues that scholars who try to categorize AA as a form of therapy do it a disservice. According to Bishop, AA can be properly taken only on its own terms as a spiritual fellowship, not merely a treatment strategy or way to modify behavior that can be couched in modern psychology.” 

Thomas McClellan, PhD, former director of the Treatment Research Institute at the University of Pennsylvania adds, “It gets under the skin of psychologists—the idea that you’re powerless, the idea that there are catch phrases and simple things done by lay people that will be powerful tools.”

Project Match's 1998 findings support the 12-Step Treatment over the two other treatment types it compared (Cognitive Behavioral Therapy and Motivational Enhancement Therapy). Dissolved in 2013, Project Match was a federal effort under the direction of the National Institute on Alcohol Abuse and Alcoholism to find the treatment type best “matched” to individuals based on a collection of personal criteria. 

The first therapy examined was AA, whose beliefs are grounded in the firm stance that alcoholism is an “incurable, progressive, and fataldisease of the mind, body, and spirit for which the only path to recovery is total abstinence.

Common tenets of AA include the mantra that “your best thinking got you here,” a reminder that the convincing efforts of the alcoholic mind—and they are deadly persuasive, as alcoholism mortality rates assert—are what led you to rock bottom. Furthermore (and this is often a bone of contention in research on the 12-step treatment), the affirmation relates to AA’s insistance that its members put faith in God, as they understand Him

Faith appears in five of the 12 steps, starting at the second, where members come to believe that a Power greater than themselves could restore them to sanity. Spirituality is part and parcel of the treatment. It should be noted, however, that the program stresses God or a higher Power as members understand Him, so there is leeway for interpretation beneath the banner of a variety of doctrines. 

The second treatment examined in Project Match was Cognitive Behavioral Therapy, developed to prevent relapse into problem drinking that relies heavily on “anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies.”

Finally, Project Match looked at Motivational Enhancement Therapy, which primarily involves therapist feedback “intended to strengthen and consolidate the client’s commitment to change and promote a sense of self-efficacy.” MET’s end goal is to help the client internalize the desire to recover so that when they are later tempted to abuse, they have an internal support system of knowledge, strategies, and perspective to lean on. 

These approaches may all seem pretty similar at first glance, but they really couldn’t differ more. And where this affects you is in their efficacy—which ones work, and for whom? Finding out is often a trial-and-error process. In the mires of a depressed alcoholic state, it can be thoroughly tempting to write off treatment after a failed experiment. When that happens, it is crucial to know that there are other options, not one end-all be-all treatment. 

So now, in defense of AA. A recent article on the “irrationality” of AA critiques the 12-step program, largely its insistence on total abstinence. AA’s reasoning goes something like this: the alcoholic has no power over the disease, and cannot have even a single drink without submitting to the disease and sliding inevitably back into addiction. It is for this reason that many “graduated” members of AA still refer to themselves as recovering alcoholics, rather than recovered alcoholics, even decades after their last drink.

With the opposing opinion is Gabrielle Glaser, author of “The Irrationality of Alcoholics Anonymous,” who uses the experience of a man identified as J.G. as an example: “Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.” 

Glaser goes on to argue that alcohol abuse has since proven to be a spectrum rather than a binary, and therefore total abstinence is not always necessary. The danger here is that it is nearly impossible to know in advance if an individual’s alcoholism can be tempered—and this is why AA preaches abstinence across the board. 

I argue that J.G. has a distorted understanding of AA’s message. AA contends that after one drink, the disease is in control; this warning is not intended to “doom” the alcoholic to a backslide in the event of a misstep, but to highlight the importance of staying in control while control is still in your hands. Call it cold turkey or call it abstinence, but at its core, AA requires an admission that when it comes to alcohol, you lose control. Your commitment to maintaining control is a commitment not to take a single drink. 

So what should you take away from this? I’m not here to drill you on red flags or remind you about the real world, because you know all that. What I want is for people to start paying attention to that nagging little responsible voice that tells them it’s not funny to joke about alcoholism. Maybe I’m being optimistic about college students’ perspective, but I think more people are worried about alcoholism than are willing to admit it. And I want that to stop. At the risk of sounding like an after school special—though really, what’s the big problem with that?—alcoholism exists, and it can ruin relationships and ruin lives. Are we really going to let it just because mentioning it might ruin the mood? 

Are we really going to let it because we’re afraid to speak our minds?

 

Note: if you or someone you know is struggling with substance abuse, please make use of the following resources for more information and help, or contact Georgia Ringle, the Student Health Center, or the Chaplain’s Office: 

National Institute on Alcohol Abuse and Alcoholism

Substance Abuse and Mental Health Services Administration