Alcoholics Anonymous saves lives – but alcoholism language can also be harmful

TV: I'm an alcoholic: inside recovery
BBC

The airing of the recent BBC documentary I'm an alcoholic: inside recovery prompted a number of interesting talking points. For one, an important tradition of Alcoholics Anonymous (AA) is its principle of anonymity, so broadcasting real AA meetings and its members to the outside world in this way is rarely seen. The hyper-real facial modification technology used to protect the identities of members was striking in itself. 

Importantly, the documentary revealed much about AA and how it works – valuable given the myths and speculation that often surrounds it. And AA does certainly work for many; the testimonies of those on the programme are supported by robust evidence that long term engagement in AA really does help abstinence-based 'recovery'. It also revealed how many aspects of AA like the role of spirituality are flexible – members can interpret of use it in ways that works for them, rather than as a rigid doctrine. Most of all, seeing the people behind the stories is valuable as it humanises people with alcohol problems, a group subject to punishingly high levels of stigma. 

However, it's no secret that AA does attract a range of criticism. One paradox of its strength as an autonomous self-help group is the potential for individuals to go beyond the parameters of the meetings and its traditions. Perhaps inevitably then, cases of predatory (sometimes called '13th stepping') or other harmful behaviours are something that can exist within any kind of social networks which are ultimately dependent on the individuals that make them up.  

Another complex issue though relates to the way in which AA sees alcohol problems and the language that surrounds it. Whilst a disease model of alcoholism also originates from a medical model of alcohol problems (and in many ways AA's texts refer to alcoholism as an 'illness' in a more metaphorical sense), AA has undoubtedly become synonymous with the idea of alcoholism as a 'disease'. This reflects part of its value to those who benefit from it. AA members learn to understand their alcohol problem as a something that cannot be cured, only managed through AA. As such, the line is always clear – abstinence is essential because 'one drink is too many, and a thousand isn't enough'. In turn, whilst the only requirement to attend AA is a desire to stop drinking, self-identification as an 'alcoholic' is a non-negotiable aspect of an AA identity. 

One consequence of the huge success of AA is that 'alcoholism' has become the dominant model for understanding for alcohol problems. The obvious question this raises for any person contemplating their alcohol use as problematic then becomes 'am I an alcoholic?'. Unfortunately, for many, this framing is unhelpful. Not only do the significant majority of people who experience harms from drinking not fit even a loose idea of an 'alcoholic', many will also be acutely aware of the heavy stigma embedded within the term. As such, a clear evidence base shows how the 'alcoholic' label can prevent problem recognition and help-seeking due to its stigma. 

From a broader perspective then, the issue is not whether or not AA works for some, but what the broader consequences of 'alcoholism' language are. Alcohol problems are undeniably broad, and exist on a continuum of severity. That is, problems are not only to be found in a distinct population of 'alcoholics', but exist in many different ways across many different groups. The vast majority with alcohol dependence sit within the 'mild' or 'moderate' zone of the dependence spectrum, are in work, and still functioning in ways incompatible with public stereotypes of 'alcoholics'. The ubiquity of the alcoholism concept therefore unintentionally obscures the many other ways in which alcohol problems can exist.

Whilst there are no single word replacements for 'alcoholism' (i.e., alcohol dependence), positive examples to build on exist. In professional contexts, models of 'alcohol use disorder' highlight degrees of severity. In real world terms, we've seen increasing numbers of people embracing 'positive sobriety', taking part in Dry January, or identifying as 'soberistas' or 'mindful drinkers'.

The broadcaster Adrian Chiles has also shown what else 'recovery' can look like, including in his new book The good drinker: how I learned to love drinking less. Chiles has demonstrated that for him, moderation is an achievable goal, and has realised many benefits from reducing his consumption. 

Publicly sharing these lesser known 'recovery' journeys show how alcohol problems and their resolution extend well beyond the walls of AA. Calling for a more nuanced and careful language of alcohol problems is not a call to curb AA, or those who self-label as alcoholics. It is a call to understand that by preventing alcoholism language from 'spilling over', we can enable more people to recognise and change other forms of alcohol 'problems' that are more prevalent, yet much less recognised.  

About the author

Dr James Morris, a Research Fellow at the Centre for Addictive Behaviours Research at London South Bank University and host of The Alcohol 'Problem' Podcast.