Is alcoholism a mental illness?
“Neurosis is always a substitute for legitimate suffering”
Carl Gustav Jung
What is a mental illness?
Before we tackle the question of whether or not alcoholism qualifies as a mental illness, it may be helpful to explore what a mental illness is. Let’s see how artificial intelligence defines the term ‘mental illness.’
- The Core Definition
“A mental health concern becomes a mental illness when it meets two main criteria:
* Persistent Symptoms: It isn’t just a bad day or a temporary reaction to a sad event (like grief); the symptoms last for weeks or months.
* Functional Impairment: It interferes with your ability to work, maintain relationships, or take care of yourself.”
Gemini AI
Would AA members agree with these criteria?
If AA members were presented with the above criteria and invited to give honest feedback about their drinking, they would offer conflicting opinions. Some would admit that, with or without a drink, they considered themselves thought-disordered, emotionally and mentally unstable. Others might even admit to being unemployable. This group may well admit to suffering from a mental illness.
On the other hand, a large group of alcoholics in AA see themselves as ‘functioning alcoholics.’ They still have their jobs, relationships, and families, and at least on the outside, appear to have normal lives. Can this group, simply because of their dependence on alcohol, also be described as suffering from a mental illness?
Is alcoholism in the DSM-5?
The DSM-5 stands for The Diagnostic and Statistical Manual of Mental Disorders. It is published by the American Psychiatric Association. It is a manual that contains all mental health disorders that have been identified and that can be diagnosed by the psychiatric profession. Has alcoholism made it into the DSM 5 as a bona fide mental health disorder? Yes, alcoholism has been classified as a mental health issue and officially named AUD (Alcohol Use Disorder.) Here is what the DSM-5 says about AUD.
“Alcohol use disorder (AUD) is diagnosed based on the DSM-5 criteria, defined as a problematic pattern of alcohol use leading to significant impairment or distress. A diagnosis requires at least two of 11 specific symptoms occurring within a 12-month period, which include tolerance, withdrawal, loss of control, and neglect of obligations.
Diagnostic Criteria (DSM-5)
A diagnosis of AUD is made if a person meets at least two of the following criteria within a 12-month period:
- Loss of Control: Drinking more or longer than intended.
- Unsuccessful Efforts to Cut Down: Persistent desire or failed attempts to control drinking.
- Time Commitment: Spending a lot of time obtaining, using, or recovering from the effects of alcohol.
- Craving: A strong desire or urge to use alcohol.
- Role Failure: Failure to fulfill major obligations at work, school, or home.
- Continued Use Despite Social Problems: Continued drinking despite relationship, social, or interpersonal problems.
- Giving Up Activities: Giving up or reducing important social, occupational, or recreational activities.
- Hazardous Use: Recurrent use in physically hazardous situations (e.g., driving).
- Physical/Psychological Issues: Continued drinking despite knowing it causes or worsens physical or mental health problems.
- Tolerance: Needing more alcohol for the same effect or diminished effect with the same amount.
- Withdrawal: Experiencing withdrawal symptoms (e.g., shakiness, insomnia, nausea) or drinking to avoid them.”
Of course, it is impossible to generalize, but it would seem from the criteria offered in the DSM-5 that, whether high functioning or not, most people arriving at the doors of AA with a drinking problem, to a greater or lesser extent, are suffering from a mental health problem.
What the AA Big Book has to say on this subject
Bill Wilson, the co-founder of AA, wrote the Big Book called Alcoholics Anonymous. It was first published in 1939. This was now 87 years ago. Was alcoholism considered a mental illness back in the 1930’s?
Here are a few interesting quotes from Bill:
“There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.”
BB How it Works, p.58
“Best of all, I met a kind doctor who explained, that although certainly selfish and foolish, I had been seriously ill bodily and mentally.”
BB Bill’s Story, P.7
“From it stem all forms of spiritual disease. For we have not only been mentally and physically ill, we have been spiritually sick.”
BB How it Works, p.64
“You can see that he is mentally and physically sick.”
BB To Employers, p.141
“Some will be willing to term themselves “problem drinkers” but cannot endure the suggestion that they are in fact mentally ill.”
12&12 Step Two, p. 33
“Now about health: A body badly burnt by alcohol does not often recover overnight, nor do twisted thinking and depression vanish in a twinkling.”
BB The Family Afterward, p.133
It would seem from the information presented that there is some compelling evidence that alcoholism is a mental illness. However, as I am about to explain, in my own personal experience as a low-bottom drunk, alcoholism is a mental illness that stands apart from all other mental illnesses.
My own experience, strength and hope
When I went to my first meeting in 1984 and experienced life clean and sober, I was in for a huge shock. Quite literally, the alcohol and drugs were the glue that held me together. It turned out that without them, my mental health was extremely poor. I could barely function. A psychiatrist quickly put me on mood-stabilizing medication.
If you are struggling with thoughts or emotions after joining AA and giving up alcohol or drugs, remember: taking medication prescribed by a physician does not prevent recovery, no matter what anyone in AA says. Only your doctor is qualified to advise on medication.
Shortly afterwards, I was diagnosed with borderline personality disorder alongside my alcoholism. In the early 80’s, the stigma around co-existing mental health issues in the fellowship was so strong that I couldn’t admit my struggles to myself, let alone discuss them at meetings.
I was on medication for years and tried various talk therapies. Medication saved my life in early sobriety, but therapy didn’t help—I just used it to rage about my childhood. Over the next 13 years, I eventually learned to function in society, became more socially engaged, and even managed to hold down a job.
Eventually, I realized mental health services had their limits. Even after every therapeutic intervention, it was clear that I still had a long way to go. I couldn’t hide the fact that I was still a mess.
The spiritual malady
After thirteen years in AA, and more relapses than I care to admit, despite my prejudice against the God word in five of the twelve steps, I got a sponsor and asked for help. I got lucky that I found an agnostic-friendly sponsor who took me through the steps in a way that worked for me. The result exceeded my wildest expectations. I describe my journey in my book, The Twelve Steps for Agnostics.
With my sponsor’s help, I had a gradual, non-God-centred awakening. This happened after he suggested I start sponsoring other agnostics and atheists through the twelve steps. My consciousness was taken to a new level of peace and happiness when I made love and service to others my guiding higher powers. These two principles were the cornerstone of my spiritual awakening. From there, my spiritual awakening has deepened, and just for today, it helps me stay well.
I guess everyone has their favourite quotes out of the Big Book—I certainly do. Because I suffered from a fairly serious co-existing mental health issue, I believed that I could only get well through conventional mental health services. However, as an agnostic, I was very cynical about the spiritual solution offered through the Twelve Steps. Yet, I began to get well through the application of spiritual principles as an agnostic alcoholic.
Here is the quote from the Big Book that is so close to my heart.
“When the spiritual malady is overcome, we straighten out mentally and physically.”
BB How it Works, p.64
In conclusion, I had to get well enough mentally so I could address the spiritual malady. What was truly amazing to me was that I discovered that the spiritual malady was the root cause of my mental illness.
In fellowship
Andy F
