Talk:Alcoholism

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Guidelines for new contributors

Welcome to alcoholism! To avoid common issues that have arisen in the past, please familiarize yourself with the following commonsense guidelines:

This article is for:

• facts about alcoholism
• facts about all conditions commonly called "alcoholism"
• all sides of alcoholism (biological, social, psychological, legal, etc.)
• standard terminology related to alcoholism
• historical perspectives on alcoholism
• modern perspectives on alcoholism
• a summary of the disease theory of alcoholism

This article is not for:

• unrelated facts about alcohol
• debating the "correct" definition of alcoholism
• opinions on alcohol or alcoholics
• creating new terminology
• advertising alcohol/alcoholism related websites
• debate over the disease theory of alcoholism

Things to keep in mind:

• Please base statements on reputable sources such as published studies and books.
• Whenever possible, cite original sources rather than secondary books/articles/websites.
• "Alcoholism" means different things to different people, if you say "alcoholism" or "alcoholic" make sure the definition you are referring to is apparent.

Merge from Alcohol abuse

The page Alcohol abuse needs so much cleanup that I think it is better than i am to cut our losses and merge it into Alcoholism. The page is full of POV, unreferenced statements, it is very far from comprehensive, and nowhere near resembles what an encylopedic article should look like on this topic. Fences and windows (talk) 19:25, 26 March 2009 (UTC)

• I would support oppose merging and redirecting it.--Literaturegeek | T@1k? 19:34, 26 March 2009 (UTC)

• Support - Merge and rewrite significantly. Much of the content is unsourced, dubious, and subject to deletion or extreme revision. Doc Tropics 19:37, 26 March 2009 (UTC)

• Comment - Some of the content in Alcohol abuse might be more appropriate in, or already be included within, the article on Binge drinking. Fences and windows (talk) 00:26, 27 March 2009 (UTC)

• Oppose - "Alcohol Abuse" is a separate listing in DSM-IV, so is perceived in the medical community as being different from alcohol dependence. And as we've discussed here, alcohol abuse and alcoholism are very different. One problem is that the public uses the term "alcohol abuse" in yet another way, one which refers more to quantity of alcohol imbibed rather than to a medical disease state. It's interesting that we might do better if we ignored terminology completely (which of course we can't really do in a dictionary/encyclopedia format). That is, we can all agree that there are some people who drink "too much." Of those who drink "too much," some have no obvious difficulties, some have acute difficulties, and some have chronic difficulties. There are also people who don't drink very much at all - but that group also includes people with no, acute, or chronic difficulties - but if they have difficulties they experience them intermittently rather than in an ongoing manner.

Now we could take that rubric and fit in alcohol misuse, overuse, abuse, dependence, alcoholism, heavy use, etc. But each word has different meanings to different people. Drgitlow (talk) 16:00, 27 March 2009 (UTC)

• Oppose - I'm with Dr. Gitlow on this one. One of the problems with the alcoholism page has always been that it's a vast topic, and everyone wants to put the full details of every variation and treatment into it, plus the arguments and the full histories of the arguments. Long ago we had to split off the Disease Theory of Alcoholism into its own page where (oddly enough) everyone seemed to have lost interest in the argument, possibly because it was no longer front and center as an issue on the alcoholism page. My preference, as with all subtopics, would be to have a discussion of the various forms on the alcoholism page, and then let each of the forms give more details on their own pages. Robert Rapplean (talk) 22:25, 31 March 2009 (UTC)

Discussion

Dr Gitlow has got me thinking now. He is correct, alcohol abuse refers to abuse of alcohol which includes people just going out one night a month and getting very intoxicated or going on a binge of alcohol for a few days even if its once a month or whatever. It *might* be an idea to merge Binge drinking into alcohol abuse and do a lot of pruning of original research and uncited data. I now oppose merging into alcoholism.--Literaturegeek | T@1k? 17:12, 27 March 2009 (UTC)

Heh heh, somehow I just knew that Dr. Gitlow and I would have an initial disagrement on this topic. That's because I tend to favor expediency, while the good doctor is a stickler for technical details and accuracy. So let me say first that I'm less concerned about where this article ends up than I am with how it ends up. Reading through the article in its current condition, it's appears that several portions were written with some basis in expertise, while others were seemingly written by a process of throwing darts at a dictionary and copying the results onto this page. I would support retaining this article as a seperate title if there were sufficient (high quality) content to justify it after cleanup. However, if what we are left with is only a couple of coherent paragraphs, then a merge would still seem appropriate. Either way, it seems more and more important to do some serious housecleaning on this page. Doc Tropics 19:04, 27 March 2009 (UTC)

Hi there, Doc Tropics. It's been a while, hasn't it? I agree that some housecleaning is in order, though overall the page is better than it was several years ago. One of the issues we might want to think about at this stage, though, is the audience. My perception is that people recently diagnosed with any condition tend to then look up that condition and read everything available on the topic. If an individual is told by a clinician that he has alcoholism (or alcohol dependence or alcohol abuse), that individual will find the Wiki entry at the top of his or her google search. So in some ways, I feel we should address the needs of that audience: How is the condition defined, how is it acquired, how is it treated, and what is the prognosis. Another segment of the audience is made up of those who want historical perspective: when was it first identified, what is different about treatment now versus treatment 50 years ago, and how does the prognosis differ now versus in years past. Still another audience segment is that of the clinician...although we have the scientific literature at our fingertips, Wikipedia is even more accessible. It is rare that clinicians do not at least read through the Wiki entry for the disease or condition of current interest.

So one of the first steps would be determining which of those questions to answer. Clearly, from all the discussion we've had over the years, there are other issues that need to be addressed: Is it a disease; how does it differ from dependence, abuse, addiction, misuse, overuse, and so forth; how and why is it that there are different treatment modalities depending upon who is carrying out the treatment. We could open with that, then move on to the rest of the article using current scientific thinking as our basis for "right" versus "wrong." Or we could break each of the subsections down, answering the questions in multiple ways depending upon approach.

For example, the treatment section could say that AA represents one commonly used approach, but that there are multiple alternatives, some of which (like Rational Recovery) have been studied to some extent.

The trouble I've had in the past is that as rewrites are attempted by one or a few authors, others edit before the rewrite is complete, inevitably leading to an entry that doesn't hold together well or which has marked inconsistencies. A way around that would be for those of us who frequent this page to do our writing via email together or in an online word document, then when we're satisfied, move it over to Wiki so that it can be assessed by everyone. Drgitlow (talk) 00:50, 30 March 2009 (UTC)

With that in mind, what is alcohol abuse? The term "abuse" all by itself has such a wide range of definitions that it basically just means "any use that the speaker doesn't approve of". It could be considered "drinking to the point of health problems", but might also be considered "doing anything involving alcohol when you should be out getting a job". It's possible that this is the kind of discussion that could cover a page on alcohol abuse, but that is actually already covered on the page Drug abuse, of which alcohol abuse is a subset.

This puts me at a disadvantage because I perceive an alcohol abuse page has having about two lines. "Alcohol abuse is a form of drug abuse that involves alcohol. Alcohol abuse may or may not be related to Alcoholism." Robert Rapplean (talk) 22:25, 31 March 2009 (UTC)

Robert, that last paragraph made me laugh. It's perfect and contains all the important points about alcohol abuse. Drgitlow (talk) 22:34, 31 March 2009 (UTC)

Alrighty, we have three opposed to the merge (LitGeek, Gitlow and myself) one in favor (Tropics), one commenting (Fences). I'll give it a couple weeks for closing comments and then remove the tag. Robert Rapplean (talk) 20:18, 13 May 2009 (UTC)

We need to get partial protection reinstated

I requested another partial protection. If they do not grant permanent partial protection, we'll need to revisit this when it wears off. Robert Rapplean (talk) 23:16, 2 April 2009 (UTC)

Unfortunately, they decided that the IP contributions overweigh the IP vandalism, and said that we really need to keep better watch on it. If this changes, they'll reconsider. Robert Rapplean (talk) 17:53, 8 April 2009 (UTC)

Long list of health issues

Some time in the past month, someone added a huge list of health issues that long-term consumption of alcohol causes. This is a side effect of alcoholism, not something that alcoholism itself does, and it is pretty thoroughly covered under Alcohol consumption and health. It definitely does not belong in the opening section of Alcoholism. Any objections? Robert Rapplean (talk) 23:27, 2 April 2009 (UTC)

I think that was me. I did wonder at the time whether it was suitable for the lead. As it has been challenged, I have just removed it from this article and moved it to the background section of the long term effects of alcohol article.--Literaturegeek | T@1k? 11:20, 3 April 2009 (UTC)

Thanks, LitGeek. Robert Rapplean (talk) 19:25, 8 April 2009 (UTC)

Agreed, Robert. Drgitlow (talk) 19:24, 12 April 2009 (UTC)

"According to studies, over fifty percent of all suicides are associated with alcohol and drug dependence, and at least 25% of alcoholics and drug addicts committ suicide."

I think that requires a reference because I don't believe that more than 50% of suicides are alcohol related and that 25% or more of alcoholics commit suicide. —Preceding unsigned comment added by 74.13.0.69 (talk) 05:34, 16 November 2009 (UTC)

Classes of alcoholism

Do the other primary editors remember when we were discussing dividing alcoholism into multiple classes based on their root causes (psychological, neurochemical, etc.)? It turns out that we were on to something. Dr. Mark Willenbring of the NIAAA said some interesting things in a recent NYT article in that vein.

About one-third of those who develop dependence do so at about age 19 to 20. For the most part, they have a relatively mild form, and almost all get well eventually. By age 25 most of them have resolved.

About 40 percent of alcoholics have midlife onset, typically in their mid-30s. They have a relatively mild to moderate form, on average. They’re more likely to have a family history of alcohol dependence or psychiatric disorders like depression and anxiety. This is the more common pattern among women. Few of them seek any kind of help, even like talking to their minister or their doctor or psychologist. Almost none of them end up in a treatment program at this point.

And then you have the other 30 percent who have a very early onset of dependence, in their midteens. Most of them have a family history, and it’s much more common among men, and they’re much more likely to have antisocial traits. They’re the ones who are most likely to develop the relapsing form of alcoholism and end up in treatment programs.

The three divisions he discusses correspond neatly to (1) those that find social value in excessive drinking that goes away when they're moved to different social circumstances, (2) those that are driven to drink because they perceive an emotional benefit, and (3) those who drink because they have an endorphinogenic addiction.

Drawing these conclusions may not be warranted, but I'm sure we can use this to improve our article. Robert Rapplean (talk) 18:20, 7 May 2009 (UTC)

Discussion regarding new dependency section

The following text was entered by an unregistered IP address. Like most initial postings by new authors, it pushes a single view point on the issue of alcoholism, and therefore I don't feel it is either appropriate or well researched. I present it here for discussion. Robert Rapplean (talk) 17:15, 14 May 2009 (UTC)

Chronic alcoholics have formed a dependency on the product. They can’t control their yearning for it and in most cases will do almost anything to get that next sip. This is why 63.7% of Americans have had an alcoholic beverage in the past year and 48.5% have consumed alcohol in the past month (Dudley p.78-79). Alcohol is used as a way to relax your body. It finds that one switch that turns everything off leaving you just to relax and feel good. Your metabolism slows down and your mental and physical energy quickly fade. Once people know how it feels to have their body shut down and relaxed. They intentionally drink alcohol to feel that way every time they are stressed and worried because it melts all those feelings away. Most chronic alcohols only have one thing on their mind. That of is course alcohol. Everything but alcohol loses its value and even things like family and reputation are pushed aside and forgotten about. Finance is no longer an issue as long as there is still money to keep alcohol in walking distance. Alcoholics Anonymous says, “The unhappiest person in the world is the chronic alcoholic who has an insistent yearning to enjoy life as he once knew it, but cannot picture life without alcohol. He has a heartbreaking obsession that by some miracle of control he will be able to do so” (Carr p.29-30)

Carr, Allen. The Easy Way To Stop Drinking. New York: Sterling Publishing , 2005. Dudley, William. Alcohol. Farmington Hills: Greenhaven Press, 2006.

I think that this commentary by a self-help guru is simply one man's opinion. While it may be based on scientific research, the individual citations for statements such as "Most chronic alcohols [sic] only have one thing on their mind. That of is [sic]course alcohol." are lacking. I suggest that we leave it out. Perhaps it could be moved to the article on Carr.Desoto10 (talk) 22:14, 24 May 2009 (UTC)

Medications

I added a bit about the conclusions of a 2008 review of topiramate.66.120.181.218 (talk) 22:02, 24 May 2009 (UTC)Desoto10 (talk) 22:05, 24 May 2009 (UTC)

Moderate Drinking Campaigns

The author of the article "Get Your Sexy Back" is trying to de-orphan their page. Would a section on Moderate Drinking Campaigns, containing a link to that article be desireable here? If so, please contact User talk:Athenak. --James Chenery (talk) 21:08, 4 June 2009 (UTC)

Dipsomania - current or historical?

72.39.37.252 seems to have added the following text to the definitions section:

The term dipsomania is used in medical and psychiatric circles to identify a condition which is characterized by the uncontrollable craving for alcohol or other intoxicants, which manifests for unknown reasons, and can be confused with alcoholism.

I was under the impression that dipsomania was a term of historical significance only. If this is the case, this should be moved to a different section so as not to crowd and confuse currently used terms. Robert Rapplean (talk) 20:57, 12 July 2009 (UTC)

You're right, Robert. We don't use the term dipsomania in medical or psychiatric circles anymore. Drgitlow (talk) —Preceding undated comment added 12:57, 25 October 2009 (UTC).

Statistic Error

Correct statistic error... previously said 24%, reference cited stated 49%.

Seems like a good faith edit, but I checked the reference and it actually said 25.5%. --Elplatt (talk) 05:37, 23 September 2009 (UTC)

Intro Creep

It looks like the latest candidate for creeping into the introduction section is the Epidemiology section. All the statistics on who has how much percentage chance of achieving alcoholism isn't actually part of the base definition of what alcoholism is, and therefore belongs in a subsection. Would anybody care to move it, or shall I do it? 17:29, 10 October 2009 (UTC)

You're welcome to move it into its own section as far as I'm concerned. I think it could also be cleaned up to replace occurrences of "alcoholism" with whatever specific criteria were used ("alcohol dependence", "dsm iv alcohol abuse", "those entering alcohol treatment programs", etc.). --Elplatt (talk) 02:36, 11 October 2009 (UTC)

Common statistical misconception

"For example, those who consume alcohol at an early age, by age 16 or younger, are at a higher risk of alcohol dependence or abuse." --This needs to be corrected. This is a common misconception of correlation. Correlation does not indicate causation. A specific reference that makes this point is Alcohol Facts and Fiction. There is also an article on wikipedia discussing this phenomenon...Correlation does not imply causation. I am deleting it from the articlePuckSR (talk) 03:02, 9 December 2009 (UTC)PuckSR

Your source is written by a professor of sociology who is employed by the alcohol industry and if I recall correctly this professor was banned from wikipedia for sockpuppeteering and disruptive COI editing. The source that you give also fails WP:MEDRS and would not be regarded as a WP:RS on this encyclopedia. You are welcome to find a recent and high quality peer reviewed secondary source for your position.--Literaturegeek | T@1k? 03:11, 9 December 2009 (UTC)

I have researched it a bit and it would seem you are correct, I shouldn't have sourced potsdam. However, I don't need a source specifically saying that people who drink before 16 are not more likely to become alcoholics. I am pointing out that this is a bit of "wrong thinking". Claiming that drinking alcohol before age 16 puts you at a higher risk of alcohol dependence is not something that should be listed as one of many "factors" that can increase your risk of alcoholism. Basically, the article as written claims that if you have a drink before age 16, you suddenly become far more likely to become an alcoholic. The two sources referenced do not support this argument. "The effects of continuous and intermittent ethanol exposure in adolesence on the aversive properties of ethanol during adulthood." was a study of showing that early exposure in mice made them less averse to ethanol later. Essentially, it proves that early exposure will make you more readily acquire a taste for alcohol. This study does not have anything to do with alcoholism. "Early-onset drug use and risk for drug dependence problems.", the other article referenced is not even a paper on alcohol. The summary of the paper makes reference to other research on alcohol, but it is not a paper on alcohol. So, as I see it, we have two articles supporting the claim that do not actually support the point being made. I would agree from a casual web-search that there are multiple sources making the claim that there is a correlation between a young drinking age and alcoholism, but I know of no study linking the causation. For example, it might be that most people who have not consumed ANY alcohol by age 16 are from cultures that do not encourage drinking, which automatically reduces the odds of them becoming alcoholics. It might also be, as the first poorly cited article mentions, that drinking at a young age makes people more likely to acquire a taste for alcohol. This would not indicate that drinking at a young age is what makes you more likely to become alcoholic, but rather liking the taste of alcohol. I just find it a horrible example of a "factor" for an addiction. PuckSR (talk) 03:21, 10 December 2009 (UTC) PuckSR