The starting point for a new look at the problem of why people drink is perhaps the reworking of our definitions. Defining alcoholism has always been a bit of an enigmatic problem. As Rohan points out, “one source of [this] conceptual ambiguity [is] in the use of ‘big fat words’” (1976:63). We must be careful to use the term “alcoholism” as a descriptor of what we mean when we see people's lives affected by alcohol and we must be careful not to allow the term to take on a life of its own. In order to be pragmatic, such a definition requires a high degree of preciseness and an emphasis on being empirically quantified. Definitions referring to some immeasurable internal state do us no good; neither do definitions that must be subjectively evaluated.
The definition proposed for this discussion satisfies these concerns. Alcoholism is defined as a physical addiction or psychological dependence/habituation on ethanol that results in a prolonged and noticeable reduction in the person's ability to function psychologically, socially, or occupationally, or otherwise negatively affects the areas of the individual's family, health or financial security.
This definition has a number of important components. Firstly, it does not matter whether the need for alcohol is physical or only psychological. The effect is the same: the person has a persistent or regular need for whatever alcohol provides for them. To argue that a person is not an alcoholic because their need is only psychological or they are only a problem drinker becomes a mute point.
Secondly, the effects of such addiction or dependence must be a result of ethanol consumption; they cannot simply coincide with ethanol consumption. For example, a person who has experienced profound personal trauma may experience a reduced level of personal functioning and may decide to increase their ethanol consumption. Such a scenario would rule out any assessment of alcoholism. If it can be determined that there were no profound personal stressors previous to the high level of ethanol consumption but that personal stressors were evident subsequent or as a result of ethanol consumption, then such a condition for the assessment of alcoholism has been determined. It is important to realize that some stressors (such as a driving while impaired offense) can be causally linked to drinking behaviour without too much difficulty, while other behaviour (such as marital strife or violence) have a linkage which is not as clear or may be only suspected. Where such behaviour cannot be causally linked to alcohol consumption, it should not be used as the sole incident in deciding an assessment of alcoholism.
Thirdly, the effect of such addiction or dependence must be prolonged. Weekend benders do not count, nor do occasional heavy drinking bouts during times of either celebration or personal distress. While such behaviour may not be particularly adaptive or beneficial, it is not classified as alcoholism. In the same way, a person prescribed Valium as a temporary measure to help them through a death in the family, or a marriage breakup, is not considered an addict to Valium.
Fourthly, the reduced ability to function in the many different areas of a person's life as a direct result of ethanol consumption is indicative of alcoholism. We do not go through the Twelve Steps with the person who drinks six cups of coffee before leaving for work in the morning, nor do we join some version of Al-Anon if we have a spouse who is a chain smoker. Similarly, people addicted to alcohol but who do not show any “prolonged and noticeable reduction in the person's ability to function” may have an addiction to ethanol, but are not considered alcoholics. People have a tacit right in our society to participate in any vice they wish so long as (a) they do not injure any other person or cause a problem for society as a whole and (b) the activity is not illegal. Related to the current discussion, this means that people have a right to consume alcohol if they wish so long as it does not impair their personal functioning or that of another person, or negatively affect their lives.
This emphasis on a noticeable reduction in functioning is what gives the definition an objective criteria and an evaluative base for assessing a person as an alcoholic. This base is important not only for statistical purposes but also for carrying out a personal inventory with the suspected alcoholic with the intent of having them accept the definition for themselves. If it can be shown to them that they are experiencing the detrimental effects of alcohol, then it should be easier for them to accept an assessment of alcoholism.
Finally, a reduction in the person's ability to function is not necessarily exhibited in all avenues of a person's life. A noticeable reduction in only a few areas, or even a single area is sufficient for an assessment of alcoholism.
The use of the term “assessment” is also very important. The medical model would prefer the term “diagnosis.” Assessment is the preferred term because that is exactly what it is: a value-free, and evaluative decision regarding the problem in a person's life, which in this case is alcoholism. We diagnose diseases, and we assess problems. Alcoholism is not a disease; it is a problem.
Alcoholics, or more appropriately people suffering from alcoholism, are like the rest of us; they suffer from problems. Their problems may be different from ours but the differences are often only cosmetic and not necessarily qualitative. Their problems may include a different genetic makeup, a particular economic or family background, historical or biographical factors, different attitudes, and different demands from their peer groups, financial difficulties, or unemployment. They differ from us only in that their attempt to find a solution to their problems led them to alcoholism and in the process, they added one more problem to their list: alcoholism.
Whatever brought these people to become alcoholics, they are not inferior to those of us who are not plagued by alcoholism. We have our own vices and solutions for dealing with our problems, some good, some bad, but by assessing a person as an alcoholic, and more importantly helping them to assess themselves as an alcoholic, we begin the first step in helping the person achieve a viable and lasting solution to some of their problems.
It might be concluded based on the preceding argument, that what is being suggested is a cognitive approach to alcoholism. Certainly, a cognitive approach is one valuable perspective to the problem. But it is also recognized that alcoholism comes in many different colours; therefore medical knowledge, classical conditioning paradigms (Siegel and Hinson, 1983; Kesner and Cook, 1983), Transactional Analysis (Berne, 1972), and other approaches all have their places in the overall program to study and assist alcoholism and the alcoholic.
The theoretical model being suggested is one which attempts to address the problem of alcoholism in an inclusive approach rather than the exclusive one of the disease perspective.
In conclusion, we wish to propose a theory which can explain the full range of alcohol addiction, even if such an explanation currently lacks specificity due to insufficient research, rather than proposing a specific but myopic approach. In this way, one of the purposes of scientific theories is satisfied, namely, to give a direction to further empirical research. As well, the theory remains open-ended as a way of permitting the inclusion both of further research as it becomes available and other treatment variables as they become recognized (Chafetz, 1978). This stands in stark contrast with the limitations of the disease model discussed above.