Alcoholism or Substance Use Disorder: tom-ay-toes, tom-ah-toes

You’re in your first year of recovery. You’re wandering around the 12 Step communities like a skittish but ecstatic puppy, loving the attention, the hugs, the jokes, the support. It’s all amazing for that hour of the meeting.

Until it’s not. One day you catch up with yourself. A crisis of confusion hits.

Joe says an addict is an addict. Carol says this is about alcoholism, not addiction. Frankie says if you don’t get God, sobriety won’t happen. Barb says Back to Basics step work is the right way. Ted says do the steps when you’re ready.

Whether you sobered up in a treatment centre or in the rooms of AA or NA, you’re probably getting a boatload of mixed messages about what it means to be an addict and how to get sober. Or clean. Or is that clean and sober? Am I an alkie? A drunk? Dually addicted? Seriously, what am I?

Maybe it will help to go back to the basics of alcoholism and addiction.

The Big Book of Alcoholics Anonymous was published in 1939 and went into great detail about the grave nature of alcoholism. Dr. William Silkworth, the medical director of Towns Hospital where Bill Wilson sobered up and had his “hot flash” spiritual awakening, wrote that the contents of the Big Book were of “paramount importance to those afflicted with alcoholic addiction.”  He wrote that “the classification of alcoholics seems most difficult” and admittedly “outside the scope of this book.”

If you’re confused now, just like back then, you are right where you are supposed to be. It’s a fluid situation.

Fast forward 81 years to 2020. Alcoholism isn’t even a “thing” anymore. At least not in the world of addiction medicine. Truthfully, it hasn’t been since 1957 when the World Health Organization concluded that the term alcoholism had lost its specificity. The late, great, oft-quoted addictions specialist, E.M. Jellinek, believed there were more than 200 definitions of alcoholism. Whether they call you a drunk, dope fiend, lush or inebriate, medical specificity of your condition has always been a problem.

The good news is, if you’re not sure what you are, that’s just fine. You’re not alone. Hang around for a while. You’ll figure out where you fit in.

It’s not just people going to meetings who are battling with definitions. By the 1970s, the American Psychiatric Association recommended the term “alcoholic problems” instead of “alcoholism” because their members felt that the latter gives the impression that all persons battling problems with their consumption of booze had a singular affliction.

By the new millennium, the American Psychiatric Association (APA) and the World Health Organization (WHO) were still adjusting their diagnostic classifications. Terms like “problematic alcohol use” and “alcohol misuse” and “deviant or excessive drinking” had given way to “alcohol abuse” and “alcohol dependence”.

More recently, the terms “substance intoxication”, “substance dependence”, and “substance-induced disorders” have become the norm.

Obviously the mental health aspect of addiction medicine has, for many decades, tried to find answers to this issue, no matter what it is called. But if you’ve wandered into the rooms of a mutual-aid society based on AA’s 12 Steps and are wondering whether you qualify as an addict, alcoholic, over-eater, sex addict, problem gambler, or any other issue you think you may have, there are a few points to consider. The 12 Step movement has some basics.

One: Dr. Carl Jung told Rowland H., the man who brought Bill Wilson’s first sponsor, Ebby T., into recovery, that the only hope alcoholics had to avoid incarceration or a horrible demise was to find a spiritual answer to their problem.

Two: Bill Wilson went on to create the 12 Steps, the 12th of which states clearly that, if you do the first 11, you will have the spiritual awakening necessary to overcome your problem.

Today, over 400 organizations are utilizing the 12 Steps and people are recovering with them, proving that, though the components of addictions may be different, the suggested solution is the same. Honesty. Openmindedness. Willingness.

It turns out that your problem is not about the substance you ingested or the behavior to which you’re addicted. It’s about the other 85 percent of the problem: Your thoughts, your bottled up or inappropriately expressed feelings, your emotional state.

The 12 steps seem to help addicted souls catalogue and assess these messes and clear the wreckage to make way for healthier approaches to life.

All you have to do is determine if you have a problem, find a way to attach yourself to a fellowship, a community of people who have a proven solution, and do what they do. And, if they identify themselves as an alcoholic at one meeting and an addict at another, then follow suit.

Black and white thinking, like your former weapons of mass destruction, is not required in recovery.

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