Are you an alcoholic?
And why this question doesn't dignify an answer....
“Are you an alcoholic?”
When I was drinking more than I wanted to, and for several years after stopping, this was the question I dreaded most. I burned with shame at the question and quenched the flames by drinking more.
Addiction isolates people, and language enables this. The words for drinking too much are loaded with stigma and shame. The heat of the A-words - alcoholism, alcoholic, addict, addiction - flock to the behaviour of excessive drinking like inflammation around a wound.
The stigma of excessive drinking has its origins in the disease model of addiction: those who lose control of their drinking have a disease of the brain, like diabetics have a disease of the body. This is thought to explains why only a subset of people who drink heavily develop a serious and life-limiting condition. It separates the ‘us’ who can handle their drink from the ‘them’ who are alcoholics.
Scientific research and lived experience cast doubt on the validity of the disease model, suggesting that problematic drinking is better explained as a continuum. It suggests excessive drinking is a progressive phenomenon. There is no ‘us’ and ‘them,’ only a single continuum of dependence on which we all exist. The science behind the continuum model is simple. The brain adapts to a psychoactive substance by becoming increasingly tolerant, which is why the more you drink, the more it takes to get drunk. The more alcohol you consume; the greater the negative impact on your physical and mental health; the more your relationships and work suffer, and the more you will rely on alcohol to cope with the problems caused by drinking. Drinking becomes like a Chinese finger puzzle – drinking to cope tightens alcohol’s grip on the brain. This end-state is how most people think of the A-words. But this state is not a different category of being; it’s just the natural consequence of playing with the fire of a mind-altering substance.
The disease model suggests people cross an invisible threshold from normal drinking into problematic drinking. From ‘liking a drink’ to ‘alcoholism.’ It relies on lists of signs, symptoms, and criteria that are supposed to define when ‘too much’ becomes pathological. I’m not sure this line exists. The development of problematic drinking is a biological and psychological journey. Everyone who lost their health, a job, a loved one, or their life because of drink took the same journey: benign social drinking became a severe and life-limiting addiction.
Our reliance on the A-words to describe growing alcohol dependence is a problem. It perpetuates stigma and activates shame. This prevents people from thinking critically about their drinking. The language of the disease model creates an ironic and dangerous double bind. Society encourages us to play with fire, then blames those who get burned. The disease model and its A-words enable this double standard. If language creates a division between those who drink problematically and those who drink normally, stigma will stop people from acting before it’s too late.
To prevent people from progressing into serious addiction, we need a non-stigmatising lexicon to describe the experience of becoming dependent on alcohol. We reach for words like ‘alcoholic’ because we don’t have alternatives. This is a problem because words create reality. Language conjures up and breathes life into things that don’t exist but take on the semblance of things that do. Think about Dragons. Dragons don’t exist in the real world, and yet the concept of dragons drives a multi-billion-pound industry. In trying to explain problematic drinking, psychiatrists tried to describe a pattern of behaviour and gave it a name: Alcoholism. They created a Dragon. They took the bones of neurobehavioural chemical dependence and wrapped it in the flesh of guilt, secrecy and shame.
Psychiatry created the dragon of alcoholism with good intentions. But it has been hopeless at slaying it. The term ‘alcoholic’ does not have any validity in modern science and clinical practice, yet it remains the dominant cultural concept for explaining problematic drinking. Millions of people feel that ‘I am an alcoholic’ is a meaningful way to describe their relationship with alcohol. However, for millions more it is a word that wreaks psychological havoc, leaving people cowering in fear, shame, and secrecy. And these responses are justified. Prejudice and discrimination against people with alcohol problems is real and appears to be increasing. There are significant emotional, social, and career risks to being open about a drinking problem. The fear of being labelled ‘an alcoholic’ kept me drinking long after the point I wanted to stop. If the only words for describing our experience of drinking too much are conduits for stigma, shame and discrimination, most people will choose silence. And if we can’t talk about our concerns, we cannot receive reassurance, help, and support.
Which brings us to the point of Control Issues, this post, and its companion post: Better Conversations (Part One). We need to talk more about problematic drinking, but we need to talk differently. Contrary to the rhetoric of Big Alcohol, the harms associated with drinking are at an all-time high. Whilst young people are drinking less, alcohol remains the primary preventable cause of death and injury in youth, and particularly young men. We are blindly walking into a public health tsunami of cancer, dementia, kidney and liver disease caused by high levels of alcohol consumption. In 2025, UK deaths directly attributable to alcohol reached their highest ever level. All this is preventable if we can get people to step off the path to serious addiction sooner. The disease model of addiction seeds the myth that only some types of people get into trouble with their drinking, leaving the rest of us to carry on without worry. If only this were true. Since sharing my experience, many others have shared their own alcohol-related concerns. Most are not people one would identify as having a drinking problem, and yet alcohol is clearly taking a toll on their lives. The disease model of problematic drinking is contributing to a dangerous conspiracy of silence. More people than we think are worried about how they drink. They just don’t know how or are too afraid to talk openly about it.
‘Are you an alcoholic?’
Not one person asked me if I was an alcoholic during the thirty years I drank heavily. After I stopped, it’s all people wanted to know, even if most have been too afraid to ask directly (see Better Conversations: Part One). It’s ironic that living well with a stigmatised condition often involves having to embrace the concepts that kept you in secrecy and shame. Many find liberation in reclaiming the labels that society uses to shame them. This is why “My name is Bob and I am an Alcoholic” holds such power for many who struggle with their drinking. But the journey to this type of acceptance is not easy. For every person who finds liberation in that phrase, there are many more who lose valuable years, and sometimes their lives, fighting against being defined in such a way. Given such harms, it might be time to retire the language of disease and invest in developing a more descriptive and scientifically accurate language that dismantles the stigma of problematic drinking.
The words used to describe our drinking have profound personal consequences. They also create ripples in the lives of others affected by alcohol and our culture. I used to agonise about how I would answer the question, ‘Are you an alcoholic?’ The dragon concept of alcoholism kept the question hot with shame. As a professional with lived experience of drinking too much, the words I use have the power to feed or help slay the dragon. It’s taken me a while to find a way of articulating why I stopped drinking that does not feed the beast. A way that was true to my experience and based in scientific reality – that integrated my personal and professional understanding of the issue. Here it is – a work in progress:
“I realised I was drinking more and more, and I didn’t like the impact it was having. My brain was increasingly dependent on a substance with dependence-forming properties, and it was limiting my life in ways that distressed me, even if friends and family were not that bothered.”
This is a good enough reason to stop drinking. In fact, it might be the best. If more people acted at this point, the individual, familial, and societal burden of serious addiction would be greatly reduced. Isn’t that what we all want?
For readers interested in the science underpinning this article…
Papers on the problems with the disease model and the stigmatisation of alcohol
Heather, N., Best, D., Kawalek, A., Field, M., Lewis, M., Rotgers, F., … Heim, D. (2018). Challenging the brain disease model of addiction: European launch of the addiction theory network. Addiction Research & Theory, 26(4), 249–255.
J. Morris, A.C. Moss, I.P. Albery, N. Heather. (2022). The “alcoholic other”: Harmful drinkers resist problem recognition to manage identity threat. Addictive Behaviors, 124,107093.
Morris J, Schomerus G. Why stigma matters in addressing alcohol harm. Drug Alcohol Rev. 2023; 42(5): 1264–1268.
Kilian, C., Manthey, J., Carr, S., Hanschmidt, F., Rehm, J., Speerforck, S. and Schomerus, G. (2021), Stigmatization of people with alcohol use disorders: An updated systematic review of population studies. Alcohol Clin Exp Res, 45: 899-911.
Articles on the record number of deaths associated with alcohol
You hit the nail right on the head! Such a good piece. Thanks for sharing.
Thank you for this clear and insightful article Paul. We can fool ourselves for years because we don’t fit our perception of an Alcoholic. Meanwhile, we gradually increase our dependence and damage to our bodies. Your answer to Are you an alcoholic? nails it I think.