I’m feeling conflicted. Specifically, about the way people in the recovery and medical arenas are trying to suppress and supplant the words ALCOHOLIC and ALCOHOLISM in an attempt to reduce the stigma surrounding alcohol addiction.
According to one social media “influencer” these words are “outdated” and just “don’t resonate” with a lot of people.
Alcoholism is deeply stigmatised and it’s well known that the shame this stigma creates in addicts is a major reason why they don’t ask for help. The stigma is so strong it is literally making addicts too ashamed to ask for help. In an attempt to side-step the stigma, some people have therefore been replacing the word alcoholism with other theoretically more palatable terms that aren’t tarred with the ‘alcoholic’ brush.
My conflict is this:
On one hand, I will always support anyone who aims to get and stay sober. The language or terminology they personally choose to describe themselves and their experience is perfect. If the language chosen helps the addict admit they have a problem and if it keeps them sober, it is exactly the right choice of language for that individual.
On the other hand, it is obvious to me that changing the name of a disease is not going to change the stigma attached to the disease.
Another issue that concerns me is that changing the terminology smacks of denial in many cases and can be dangerous when pushed on others in a more vulnerable position. Alcoholics will clutch at any explanation that tells them they are not an alcoholic. Denial of the disease is a key aspect of the disease. That is the nature of addiction.
The medical community have decided to rename Alcoholism as Alcohol Use Disorder. Alcohol Use Disorder (AUD) is defined by the National Institue of Alcohol and Alcoholism (USA) as, ‘a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences … Considered a brain disorder, AUD can be mild, moderate or severe’. I can’t find any use of the word ‘alcoholism’ or ‘alcoholic’ on the UK National Health Service (NHS) website other than in reference to Alcoholics Anonymous (AA).
Earlier this year I was confused when my GP removed ‘alcoholism’ from the front page of my current medical notes and added ‘alcohol use disorder’ to a background page of less relevant medical history. Having researched the changing language within the medical community I now understand why she did this. But I have promised myself that at my next appointment I will make her reverse the changes to my medical record. It is extremely important to me that anyone who treats me is aware that I am an alcoholic and it shouldn’t be dismissed as no longer relevant as it is a lifelong diagnosis.
Providing alternative names for the disease is definitely helpful for some people. The spectrum of alcohol addiction certainly does range from mild through to severe and I am sure that identifying as having mild or moderate AUD would make asking for help easier to do. The wide selection of alternative names for alcoholism reflects our differing experiences. Alcohol abuse, problem drinking, alcohol addiction, alcohol dependance, binge drinker, grey area drinker, alcohol misuse, are all ways to describe a degree of alcohol dependance or addiction.
But simply changing the language of alcoholism is frustratingly ineffective if we want to stop problems with alcohol being stigmatised. Brushing the word alcoholism under the carpet like our embarrassing drunk relative we must never speak of again, is never going to challenge or change the stigma associated with the word alcoholic. If anything, it is reinforcing the stigma. By no longer using the word because it is too strongly stigmatised, the medical community are inadvertently reinforcing that Alcoholism is shameful, and that Alcohol Use Disorder isn’t. It also enables addicts to unwittingly reinforce the stigma. People with a serious drinking problem now have the power to say, I’m not an Alcoholic, I have Alcohol Use Disorder.
Changing the name of something is not going to change the way society as a whole view that something. People with alcohol addiction will still be subject to judgement and discrimination from the public and clinicians regardless of the official name of the disease.
If we genuinely want to help Alcoholics feel less shame, then campaigns to educate the general public about addiction are required. We need society to understand that addiction is not a personal choice, or a moral failing, or a lack of will power. Addiction is biochemical, not psychological. If the real goal is to help addicts seek and achieve lasting recovery, then a concerted effort needs to get underway to remove societal judgment of addiction and replace it with understanding and support. This would be far more effective and powerful than changing the name of the disease. Until then, addicts will always feel shame because we will always be stigmatised. We need to smash the stigma of alcoholism and addiction if we want to provide addicts with a chance of recovery.
Before I launch into this next section, please note I am not referring to all sober coaches or people who advocate for alcohol free lifestyles. There are so many amazing people doing extremely valuable work out there!
That said, I am angry at some ‘influencers’ who promote the new AUD terminology in a mostly self-serving way. A lot of these people are sober coaches or similar and are seeking a more socially acceptable way to describe their addiction and promote their business. I was stopped in my scrolling tracks recently when I saw an Alcohol-Free (AF) Life Coach post a photo of herself with the text, I AM NOT AN ALCOHOLIC. She went on to say that the ‘alcoholic label’ just ‘didn’t seem to resonate’. On that, I have an Autoimmune Inflammatory Bowel Disease called Ulcerative Colitis. That doesn’t fit with my image as a Fitness Professional, or ‘resonate’ with me, but it doesn’t make it any less real.
This AF Life Coach stated in one post that she cannot just have one drink because she cannot stop drinking after the first, yet in a different post she says, ‘I drink as much as I want, whenever I want, I just don’t want any’. This life coach encourages followers with similar alcohol problems to identify as having AUD and goes on to say that if you are no longer drinking then you don’t have AUD anymore. Because if you are not drinking alcohol, how can you have a problem with alcohol? Interesting …
I have a huge amount of respect for anyone who is honest and open about their addictions and those working in the recovery space, but this kind of messaging smells off to me. I am sure that many people have found lasting sobriety by adopting this approach and I don’t doubt that this woman means well. But for many, this messaging is extremely dangerous. The key to sobriety for many people with alcoholism or severe AUD, is a powerful awareness that they can never drink again. I quote I saw recently gets the point across perfectly. The quote ran “I am one drink away from never being sober again for the rest of my life”. That is what people with severe AUD (alcoholism) need to hear. Not that they can drink if they want to, they just have to choose not to. This twisting of words provides a diversion of focus away from the indisputable seriousness of the disease of alcoholism and could in some cases prove to be quite literally a matter of life or death.
In addition to this misguided down-playing of the seriousness of severe alcohol addiction, this influencer is also using the stigma of alcoholism to her benefit and to promote her Life Coaching service. She states that she identifies as having had AUD in the past, rather than as an alcoholic, because (her words) ‘after all, I am a successful, fully functioning woman, managing work, family and responsibilities well’. Can you see what’s happening here? Reinforcement of the stigma around alcoholism by implying that ‘successful people’ can’t be alcoholics. And inviting her followers to buy into that stereotype and shun being ‘labelled’ (I prefer the word diagnosed) as an alcoholic.
To sum up, I am very conflicted!
I am one hundred percent rooting for everyone currently struggling to beat alcohol or other substance addiction. Addiction on any part of the spectrum is a horrendous experience. I support everyone’s individual, varied paths to sobriety and support their choice of tools and mechanisms used for staying sober. In fact, it’s none of my business how people get and stay sober. My business here is in providing people in addiction and in sobriety hope and inspiration. And to be a cheerleader for those fighting the disease of alcoholism because it the fight can be won.
And yet, I feel fired up and angry at the way the name of my disease, ALCOHOLISM, is being dismissed and the ramifications of this. It’s NOT a label. It’s a medically diagnosed disease. If this word is being erased from medical terminology, where does that leave everyone who has spent years coming to terms with their diagnosis as an alcoholic? I have found great strength and empowerment in accepting that I have the disease of alcoholism and I am not ashamed of it. I own it and I won’t let that be taken away.
I’m angry because I am scared. I am scared for all the alcoholics out there who may be lulled into a false sense of security by the changed terminology and the different interpretations of AUD available online. Someone once compared alcoholism to cancer. You can achieve remission, but you can never be completely sure that the disease won’t come back. That’s the reality of the disease. It doesn’t go away when you stop drinking.
If the stigma attached to the word alcoholic continues to be reinforced alongside the supplanting of the word Alcoholic continues, what will happen to the invaluable service provide by the largest, free, worldwide, support system available, Alcoholics Anonymous? It’s already hard work convincing people to go to AA meetings, we don’t need to stigmatise this group further!
Did I over think it? Maybe! Should I get so wound up about the language of addiction? Maybe not. But writing it down did help me work through it!
Thank you, always, for reading My Secret Sobriety.
Please feel free to comment below. Kate xoxo
Another great article Kate! I fully agree with you!!! My thinking - when you are drinking and you know you have a problem, but you never want to be called an alcoholic, or a lush or an alky or any number of titles. It's embarrassing and humiliating! Which is good - it pushes you towards recovery. Fast forward to recovery - now the term alcoholic is a badge of honor, you are eager to keep others from falling in to the same trap; you are part of a community, like it or not. It is part of who you are - and you have no choice. You can and drink and be an alcoholic - you'll just never find out if you have that affinity for overindulgence if you choose not to drink! We are all addicts, everyone! If anyone took heroine long enough, they would get hooked - thus an addict. I'm an heroine addict who's never tried heroin!🤔
You can rename Cancer to "Cotton Candy", it might make you feel better, but you still have CANCER!☠
Bottom line - you can't polish a turd!💩
As someone who is sober for one year, I needed all the help I could get. Thank you for the constant reminders and words. They are necessary.