Primary, Progressive, Chronic and Fatal: An Alcohol Problem is Nothing to Fool Around With

Alcohol is the single most abused drug in America. Although it is legal and can be used safely in moderation, about 10% of the general population exhibits alcohol abuse and/or dependence. Alcoholism is more prevalent in males than females, but has probably been under diagnosed in women because of social stigma and sometimes confusing differences in how it manifests. According to the “disease model” of alcoholism, the addiction is primary, progressive, chronic and fatal. The latter three of these descriptors speak for themselves. And alcoholism is characterized as “primary” because it is assumed that the addicted person’s medical or psychosocial problems cannot be successfully resolved until the alcohol problem is treated.

The disease model approaches alcoholism as a disease of the mind, body and spirit which requires a lifelong recovery process. There is no such thing as a cure; even after abstaining for long periods, and alcoholic will inevitably lose control again if he or she resumes drinking. There is research evidence for a strong hereditary predisposition to alcoholism, one component of which seems to be an inability to properly metabolize alcohol. However, twin studies (which look at addiction rates of identical vs. fraternal twins, or of identical twins separated at birth and raised in different families) also document the importance of environmental factors in the development of alcoholism. While “problem drinking” can seem like a subjective concept, the American Psychiatric Association’s Diagnostic and Statistical Manual IV (DSM-IV, 1994) has clear diagnostic criteria for substance abuse.

A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within the same 12- month period:

  • recurrent substance use resulting in failure to fulfill major role obligations at work, school or home
  • recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile…when impaired by substance use)
  • recurrent substance-related legal problems
  • continued substance use despite having persistent or recurrent social/interpersonal problems caused or exacerbated by the effects of the substance

Alcohol abuse can be related to situational stress, but anyone who tends to cope in this manner should assume that he or she is at risk for alcoholism (i.e., substance dependence in the DSM-IV). And an alcohol addiction can develop quite insidiously. Many alcoholics continue to function superficially well until the middle-late stage of the disease, by which time they might have done irreparable damage to their health, career and/or personal life. Even when the addiction has become obvious, the alcoholic is usually the “last to know” because of impaired judgment/perceptions and the phenomenal denial that is a hallmark of the disease.

What can friends and family do to help someone with an apparent alcohol problem? The most important thing is to stop enabling. “Enabling” is characterized by misguided attempts to help that actually make it easier for the alcoholic to stay in denial and continue drinking. It is easy to enable an addicted person for several reasons, the first of which is just not knowing how to respond effectively! Other issues might include: one’s own denial of the seriousness of the problem; the illusion that alcoholic will get better if there is less stress or if people are more understanding; and wanting to avoid conflict with the addicted person. The desire to avoid conflict is understandable, because alcoholics and other addicts can get prickly and defensive when others try to hold them accountable.

While one might recognize the need to stop enabling, it is usually helpful to get some guidance about how to proceed with this. Unlike many other emotional/psychological problems, alcoholism does not respond well to direct confrontation. Trying to control how much an alcoholic drinks, expressing concern for his or her health & safety, or even sharing one’s hurt feelings can actually provide justification for more drinking (i.e., now the addicted person feels “nagged”, misunderstood, or unfairly treated). With rare exceptions, the only way an alcoholic gets motivated to seek help is by experiencing the negative consequences of the addiction without interference from well-intended others.

Mental health professionals who specialize in substance abuse treatment can be a valuable resource for anyone with questions about how to address the complex issue of alcohol abuse. Also, many workplaces have employee assistance programs that provide confidential assessment and referral services for people concerned about their own or others’ drinking. Tackling an alcohol problem is never easy. But those who have the courage to do so are rewarded with the opportunity to reclaim their lives and, as they say in Alcoholics Anonymous, attain a genuine sense of peace and serenity.


  • Al-Anon and Alateen, Maryland & DC
  • Al-Anon and Alateen, N. Virginia
  • Alcoholics Anonymous (Metrowide information)
  • Comprehensive Addiction Treatment Services (CATS; Fairfax Hospital)
  • Fairfax County Alcohol and Drug Services
  • Kolmac Clinic, (Suburban MD and DC)
  • Suburban Hospital Addiction Treatment Center