The word alcoholic seems clear, almost obvious. He often reminds us of someone who has “a problem with alcohol” and who has, in some way, missed something. Behind this very loaded term, millions of people experience a recognized illness, with well-described mechanisms and possible treatments.
Habits have changed: among American high school students, the proportion of young people reporting having drunk during the year has been halved in twenty years, and French surveys also describe a drop in risky drinking at 16 years old. But alcohol remains a massive public health issue, with approximately 28 million people affected by alcohol use disorder in the United States and several million in France. The words we use to talk about it carry a lot of weight, says Kathryn McHugh, associate professor of psychology at Harvard Medical School and director of the Stress, Anxiety and Addiction Research Laboratory at McLean Hospital.
Why the word alcoholic is based on an outdated view of alcohol
For psychologist Kathryn McHugh, “The term “alcoholic” refers to an old conception of drug addiction, seen as a permanent personality trait, or even a moral weakness. This term was used in the 1950s and 1960s, within the first diagnostic systems for psychiatric disorders, even though we had no way of measuring dependence“, she explained in an interview cited by Harvard Gazette. The label then sticks to the person, as if it summed up their entire identity.
With decades of research, the clinical vision has changed. The classifications abandoned “alcoholism” in favor of “abuse” then “alcohol dependence”, before adopting in 2013 the notion of alcohol use disorderon a continuum of severity. Alcohol is no longer seen as a personal vice, but as a disorder, comparable to other chronic illnesses that can be treated and stabilized.
Behind the alcoholic label, a frequent illness and multiple trajectories
In France, between 1.5 and 2 million adults are alcohol-dependent, and 5 to 6 million consume alcohol which exposes them to risks. For a long time, a simple model prevailed: crossing a threshold, becoming an “alcoholic” for life, and having to stop completely in the hope of getting better. “Historically, it has long been believed that once a certain threshold has been crossed, once you are an “alcoholic”, abstinence was the only option. But the data does not support this idea. There are many different paths“, recalls Kathryn McHugh.
In fact, some will spend years between treatments and resumption of consumption, others manage to reduce their alcohol sustainably without aiming for zero, still others choose total sobriety and stick to it. Care teams today seek to personalize the objectives: reduce the damage, regain control, or stop completely, rather than freezing the person in the status of “alcoholic”.
Saying alcoholic or talking about a disorder: a word that changes access to care
The recommendations of many addiction specialists advise against identity labels such as “alcoholic”, “addict” or “addict”. This type of word reduces the person to their disorder and reinforces moral judgments, where formulations like “person affected by an alcohol use disorder” or “person dependent on alcohol” leave room for the complexity of their history. Studies show that this simple change in vocabulary orients more towards a caring response than towards punishment.
The picture is not black and white, however. “That said, many people find it helpful, given the significant impact this disorder has had on their lives, to identify as “alcoholics.” It’s an interesting paradox from a stigma perspective: we’ve really moved away from the term as a discipline, but some people find it powerful as individuals.“, observes Kathryn McHugh. Between respect for this reappropriation and concern not to stick a label straight away, the choice of words remains a first concrete step to open, or not, the door to help.