Four out of ten students could be turned into 'alcoholics' next year. Is that fair?
Will the new manual turn her into an alcoholic?
Up to 40 per cent of student drinkers could be classified as alcoholics, according to the revised "bible" of psychiatry, scheduled for publication next May.
I know what you're thinking: only 40 per cent? Have these guys been anywhere near a college pub crawl?
But, actually, the new criteria set out by the American diagnostic manual DSM-V could end up doing something really stupid: that is, persuading four out of ten student drinkers that they are suffering from a "disease", which is how most addiction specialists in the America and Britain (heavily influenced by Alcoholics Anonymous) regard addiction.
Here's the problem: earlier DSM volumes distinguished between "abuse" of drugs and "dependence" on them. The first term is now regarded as too judgmental (of course) and the second is regarded as unscientific, because dependence on something isn't the same thing as addiction. Are diabetics addicted to insulin, for example?
As this article from Time explains, DSM-V "will have just one diagnosis for addiction problems, though it will be characterised as either mild, moderate or severe". So student boozers who get wasted once a week could be labelled as "mildly" addicted. And the result? As Time points out, since the name for alcohol addiction is alcoholism, the new manual "will also tremendously elevate the number of people considered alcoholics. One Australian study suggested that using DSM-V definitions will increase the number of people diagnosed with alcoholism by a stunning 60 per cent."
This is just the sort of methodological dilemma that haunts addiction studies. I've been researching this subject for my book The Fix and the blog that goes with it. Let me leave you with two slightly conflicting thoughts.
1. Using the word "alcoholism" in the context of student binge drinking isn't as over the top as it sounds. In recent years, especially in Britain, student drinking sprees have involved the planned ingestion of massive quantities of booze, often combined with clubbing drugs. Perhaps the overall consumption of alcohol by students hasn't increased hugely in the past 20 years, but the way it's consumed is more "alcoholic", in the sense that it's assumed that nearly everyone taking part will get wasted on a particular evening. The fashion for "pre-loading" underlines the trend towards using alcohol as a calculated mood-changer. Add MDMA etc into the picture and you have some serious tinkering with brain chemistry going on.
2. Slapping the "alcoholic" label on young people is counterproductive if it encourages them to buy into the "disease model" of addiction. As Time points out, "most addiction treatment programs encourage them to see themselves as having a chronic, relapsing disease that requires a lifetime of attendance at 12-step meetings to keep in check".
It's a tricky one. I know from experience that what seems like harmless boozing in the company of similarly thirsty contemporaries can develop into alcoholism. But I also know from experience that 12-step dogma can leave people trapped in a situation in which they define themselves by their addictions. Any ideas?
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