Who Am I Kidding?

A question about alcohol and authenticity.

Dear Sober Lady,

I have been obsessing over getting sober now since at least 2013; the first email I ever sent to my wife about being concerned with my/our alcohol intake was 2008. 

I’ve been through a lot of tragedy in the last two decades: the loss of my dad in a car accident, the loss of my cousin to suicide, my excision from my family, becoming an eldercare manager to my mentally ill mother, virtual destitution. One of my crutches—it worked every time—was to drink myself into a blackout to not feel the pain; my wife did it with me, ostensibly because she loves booze as much as I do and didn’t want me to drink alone. (I used to think she has an off-switch but now I’m not sure.)

Four things drove me to obsession with sobriety: first, the time I was watching TV late one night after my wife had gone to bed; I tripped over my own feet and went down, landing on my face, and woke up with carpet fibers in my mouth. Second, the time I was leaning over our “bar” to make myself a cocktail, lost my balance, and broke the bar, which was my grandmother’s walnut end table from 1933. I don’t know what I told my wife when she got home, but she just propped one of the broken legs on a pile of books, and all was forgotten. Third, my doctor telling me I needed to stop drinking because my liver is in bad shape (and has been since I was 17, when I was ill with hepatitis), I went through at-home medically supervised detox, and the associated sobriety lasted for 43 days, after which I said “One glass won’t kill me….” And fourth, I think about wine constantly, in part because I used to be a food professional. Now that I’m not, I still think about wine every time. 

I have been in and out of AA, which often makes me want to scream. I’ve been in and out of other AA-type programs. It holds for a little while, but then it doesn’t. Often, I’d come home from an AA meeting, pour myself a glass of wine, and review the meeting. I’ve not always been truthful with sponsors. I found professionals to help me get and stay sober, and it was a psychopharmacologist who said, “I don’t think you’re an alcoholic; I think you have an alcohol abuse disorder.” Oh, good to know. 

Here I am now, in my early sixties, still married, still drinking, promising myself I’ll stop, saying all the right things, and nope. Still drinking. Because I’m not really an alcoholic…right? 

Signed,

Drowning

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Hi Drowning,

Thank you for writing. I’m sorry for the losses you’ve experienced, and I deeply relate to the way you use alcohol to numb the pain. One of the most insidious things about alcohol is how remarkably effective it is at—however temporarily—anesthetization. How could we not fall in love with such a readily available and socially acceptable balm? 

But it comes with consequences. Your grandmother’s walnut end table, a battered and bruised liver, and a decade of obsessing about sobriety because it’s the logical way out, even if it’s easier said than done. 

I had to laugh when I read the part of your letter where the psychopharmacologist says, “I don’t think you’re an alcoholic; I think you have an alcohol abuse disorder.” These can be useful distinctions clinically but aren’t inherently so. Clinicians can sometimes become so focused on terminology or a diagnosis code that they miss the point of why you’re in their office in the first place. Who gives a shit if it’s alcohol use disorder or alcoholism? Isn’t the point that you have all these neon signs in your brain (and a doctor) telling you that you need to stop drinking? Aren’t you in this person’s office because you’re asking a medical professional for help in that endeavor? 

Alcohol use disorder (AUD) is a spectrum—alcoholism is simply an older term for the severe end of that spectrum. Maybe the psychopharmacologist was trying to update your terminology, albeit in a pedantic and unhelpful way; maybe they just need to pull their head out of...the DSM-5 and touch some grass. 

Labels only matter if they help distinguish one thing from another. From everything you’ve told me, you have a pretty solid history of your alcohol use causing problems in your life and continuing to drink despite those negative consequences. Whatever you want to call it, that’s how you know that something needs to change. 

And you know this! I know you know this because, commendably, over the years, you’ve taken different steps in hopes of achieving sustained abstinence from alcohol. Your brain would not be “obsessing” about sobriety if you didn’t understand that the alcohol scales have tipped and it’s officially doing more harm than good in your life.  

I can’t tell you if you’re an ‘alcoholic,’ but I can tell you that it doesn’t matter. Even AA, with all its seeming rigidity, is careful to note that the only requirement for membership is a desire to stop drinking—not a medical diagnosis of alcoholism. (Again, now that clinicians are using AUD, a medical diagnosis of alcoholism isn’t really a thing.)

I have a feeling that your resistance to the word ‘alcoholic’ is less about broad societal stigmatization (which is one of the reasons clinicians now use AUD) and more about what it means for you personally. Perhaps you, like me, tend to think of alcoholics as people who can’t drink in moderation. It’s one of the reasons I am so comfortable calling myself an alcoholic and why I refuse to slap the label on anyone who hasn’t already adopted it for themself. I don’t know what anyone else is capable of. I do, however, know what I’m not capable of. 

Regardless of whether you ever decide to call yourself an alcoholic, you have a really good reason to try to get through the days without booze: your doctor says your liver is in bad shape, and you need to stop drinking. You didn’t specifically ask me for advice about how to do that, but I want to mention a couple of things that jumped out at me in your letter. 

First, I doubt you’re still seeing the psychopharmacologist you mentioned, but I’d strongly suggest working with a medical professional who is both knowledgeable and practical when it comes to substance use and addiction. Someone who understands your goals and is interested in helping you achieve them. I can’t stress enough that I am not a doctor and am not giving medical advice, but it might be worth asking your doctor about medications like naltrexone and acamprosate, which have solid histories of helping with alcohol cravings. They may not be recommended given your liver condition, so make sure you’re disclosing everything to the relevant doctors. 

I’m glad you mentioned going through a medical detox. As you clearly know, quitting cold turkey can not only make the process harder, it can be extremely dangerous. So, if you do decide to quit, please work with your doctor to determine the best, safest way. 

The other thing that gave me pause was how you characterize your wife’s drinking. I’m not here to make any assumptions about whether or not she “has an off switch,” but it sounds like she’s a willing and able drinking partner. What has her attitude been towards your attempts to get sober? Would she be willing to make changes like not keeping alcohol in the house if it helped you maintain sobriety?

I ask for two reasons: 1) it’s easier to avoid drinking wine at home if you don’t have any wine at home, and 2) having people around who support your decision to quit drinking can make something that’s often hard and lonely infinitely less so. I know you don’t love AA, and that’s fine (who among us has not wanted to scream in an AA meeting or 50?), but find people you can talk honestly and openly with about your drinking. Do you have any friends who would be supportive of you trying to get sober (bonus points if they are not huge drinkers themselves)? Friends of friends? Can you go to a recovery meeting (AA or otherwise) without the intention of doing the whole program (forget about sponsorship and all that for now) and just talk to people and see if there’s anyone you connect with who could be a coffee buddy and sounding board? 

I think one of the reasons the word ‘alcoholic’ is scary to people is because there’s so much stuff that we assume goes along with it. Well, if you’re an alcoholic, you can’t drink; you have to do a Program, you have to find new friends, and on and on. Put all of that out of your mind and focus on finding people you can talk to. Even if you only talk about quitting drinking and never do it—just start by opening up this part of your brain to a few people you trust. 

Alcoholic or not, you have a really good reason to try to cut booze out of your life: your doctor says you have to. But if it were as simple as that, you would have done it already. Something is making it hard—don’t worry about giving a name to what that thing is. Right now, it’s just a thorny tangle of wine, painful losses, marriage, broken promises, illness, and probably a zillion other things. The more you talk about all of this, the more you can untangle each of those threads and begin to parse out how each affects your relationship with alcohol.  That is far more important than any single word or diagnosis. 

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I’m not a doctor or mental health professional, so my advice shouldn’t be construed as medical or therapeutic advice. You are free to take or leave it.