by Deric

Joseph Nowinski, a clinical psychologist,  and Robert Doyle, a clinical psychiatry instructor at Harvard Medical School, recently wrote a book called Almost An Alcoholic: Is My (or My Loved One’s) Drinking a Problem? that outlines problem drinking as a continuum that includes a gray area (“almost an alcoholic”) beyond the dichotomy of “alcoholic” and “not an alcoholic” (DSM IV criteria of alcohol dependence and alcohol abuse versus no problem).  Classifying things, especially if we hold on to them too tightly, can sometimes get us into trouble. By being so exact, we can miss things that we shouldn’t.  And I question whether this is the case with how alcohol and drug use are defined clinically.

Promoting the book, the two authors recently wrote this article on TheAtlantic.com quickly summarizing the books points and their proposal for how redefining drinking can also change the way we conceive it, discuss it and treat it.

We believe that, as opposed to thinking only those men and women whose drinking has progressed to the point where they need help, that many people in the mid-range may also be suffering as a result of drinking. That suffering may take the form of declining job performance and declining health so that the individual does not yet recognize it as being related to drinking.

Their stance is aligned with proposed revisions to the DSM that would shift away from the two clinical definitions and toward a spectrum.  It also fits in with Screening and Brief Intervention (SBI) and how important it is to identify unhealthy drinking in patients and intervene before it becomes a larger problem.   Screening uncovers patients who may be drinking in amounts that are hazardous to their physical, mental and/or social health.  These are often people who would not traditionally be defined as dependent or abusers, and having a tool to identify this “hidden population” of drinkers can prevent future illness, injury, personal consequences or addiction.  Brief intervention is then a way to discuss a patient’s alcohol use and motivate that patient to make the healthy changes that reduce the ways drinking can be a problem in one’s life.

Edited by Llaen Coston-Clark