How can we really define and diagnose alcoholism?
It isn’t always easy. As far back as 1938, the AA pioneers had trouble defining an alcoholic as they formed what is now the General Service Board. The simple definition, “a sick person who couldn’t drink at all,” didn’t work for legal purposes. So they gave it up. Since then, we’ve trudged our road of happy destiny without a real definition that wraps it up in a few brilliantly crafted sentences. As for diagnosing alcoholism—well, the AA idea is that people must diagnose themselves as best they can.
I’ve privately thought of an alcoholic—at least myself—as a person who uses alcohol compulsively, excessively, and destructively as a mood-changing drug. I also like that concept gleaned from the Big Book: a person who suffers from an allergy of the body and an obsession of the mind. (We shouldn’t go too far with that one, however, because “allergy” doesn’t really fly with the medical community. I prefer using “physical susceptibility to alcohol” to make the same point.)
Following the lead of the medical sciences, however, I realized that the right way to diagnose alcoholism is to look at the symptoms. Scanning my own embarrassing past, I could find twelve such symptoms which should convince any person that he or she is one of us. Simply put, an alcoholic is a person who shows these symptoms. I have frequently talked about these symptoms while sharing with other alcoholics in AA discussions or in talks at AA meetings. Here they are, a list of twelve for anybody who wants to use them:
1. Couldn’t quit drinking even when my posterior was dropping off. While I never had much in the way of status or possessions. my alcoholism quickly stripped me of what little I had. I swore off after waking up in jail, after passing out on the street, after being beaten, humiliated, or rolled. Swearing off or cutting down never worked, and it hasn’t worked for countless other AAs I’ve met.
2. People started calling me a drunk. Though I tried to deny it, word got around that I was a drunk. Moving didn’t work; people in my new locations quickly got the same idea, proving that gossip seems to travel. It was almost as if a large “D” had been tattooed on my forhead. Some bartenders seemed to read it almost intuitively and would shut me off even before I’d had enough drinks to become really obnoxious.
3. I failed at the drink-switching game. I tried one beverage after another, hoping there’d be one that wouldn’t turn me into a slobbering wretch or leave me with a terrible hangover. They were all the same in the long run because they all contained alcohol.
4. The “hair of the dog” became routine. I can’t remember when I learned to medicate my awful hangovers with more drinks the next morning. I may have done this even before I learned that this was taking “some of the hair of the dog that bit me.” And I was doing it long before I learned that this practice is another symptom of alcoholism.
5. Watching controlled drinkers made me feel envious and weak. Time and again, I felt wretched and ashamed in the presence of people who could take a drink or two and then go about their business. Secretly, I berated myself for my lack of will power and vowed I would become one of them. It never worked.
6. Drinking made me a “problem person” to other people. My way of drinking caused rumbles with others. While drunk, I once took a cab thirty miles without having a cent to pay the driver. I insulted people over the telephone. I borrowed money without paying it back. I told lies while drinking and then told other lies to cover them up. The list goes on and on—all things that don’t belong in a sane, manageable life.
7. Drinking caused home problems. I had no real home of my own, but my drinking brought trouble wherever I lived. I was kicked out of a rooming house for wetting the bed. A relative who put me up temporarily asked me to leave within a week. I lived with my parents for a time, and finally wore out their patience. For a while, I was even homeless, although the term then was vagrancy.
8. Frantic, compulsive drinking overtook me. Once started, I wanted to drink continuously without interruptions for any other activity. I wasn’t invited to parties, but I would have snatched extra drinks had I been so favored. I hated to drink with people who could control their drinking or preferred a more leisurely pace.
9. Denying the problem, deluded about the seriousness of it. Looking back, I am now amazed that I could have had so many delusions about my drinking. I was aided in denial be observing a few others whose drinking seemed to be even worse than mine. Long after I was way out of control, I continued to believe that I might somehow either quit or moderate my drinking.
10. Getting fired, being rejected. I was fired several times and also shunned by others once my drinking problem became apparent. The main reason for being fired was absenteeism caused by drinking, but alcohol-related character defects also caused some of my employment problems.
11. Blackouts, or whatever you call them. I had many experiences of forgetting an entire evening. A few weeks before taking my last drink, I apparently caused a shameful disturbance in a bar, but never recalled a single moment of it. It was also common, while drinking in a bar, to notice that two or three hours had elapsed during what I thought was a few minutes.
12. Mounting regrets. Despite my denials and delusions, I had numerous regrets about the damages and costs of my drinking problem. In rare moments of honesty, I was beginning to see how it was wrecking my life and hurting others.
Those were my Twelve Symptoms, and they had the cumulative effect of prodding me into AA. The memory of the pain and humiliation they caused has helped keep me sober since April 15, 1950. If anything, the memories of the symptoms have become sharper with the passing years, serving to dislodge any belief that I might somehow drink again in a controlled manner. I never want to revisit the distressing life that included these symptoms, which did disappear when I got sober and stayed that way.
Does one have to have all of these symptoms to be self-diagnosed as an alcoholic? Not at all; having even a third of them surely means that the individual is well into the danger zone. Yet I believe that a large number of AAs could honestly say that they had most of the symptoms in one degree or another.
I’d like to offer My Twelve Symptoms to the drinking world, but it’s not necessary. AA World Services has already done this job. In slightly different forms, the Twelve Symptoms are discussed in two AA conference-approved pamphlets. One is titled Is AA for You?; the other, Is AA for Me? You can use either of them to go over your own drinking problem or to help others walk through theirs. Honest answers to the questions in these publications could be the keys to real understanding of one’s problem and continuing recovery.
“Twelve” also seems to be a lucky number in AA. Bill W., in writing the Twelve Steps, even linked it up with the Biblical use of the number. Then we went on to have the Twelve Traditions, the Twelve Concepts of World Service, and even the Twelve Promises. I never realized until lately that my alcoholic symptoms added up to Twelve. But talk about lucky numbers! Facing my Twelve Symptoms was one of the luckiest things that ever happened for me
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