by Alan Brandis, Ph.D.

Alcoholism could be referred to as "the disease that makes you think you don't have it." Alcoholics rarely believe that they have the disease, or they minimize it in other ways such as by comparing themselves to even heavier drinkers. They develop elaborate belief systems to defend themselves against the realization that they are not in control of their drinking any more, such as "I could quit any time, I just don't want to" and "I have a good job, a house, and money, so I couldn't be an alcoholic." They make up rules which, they believe, ensure that they cannot be alcoholics, such as "I only drink fine wines" or "I only drink after 5:00 PM."

Denial, a psychological defense, is used by alcoholics extensively so they do not have to admit they are alcoholic. It can be blatant denial such as "My drinking is not a problem," or more subtle, such as "I'm planning to cut down right after the holidays." It can even be in the form of humor, such as (on a T-shirt): "I don't have a drinking problem - I drink, I get drunk, I fall down, no problem!"

Anyone who experiences negative impacts related to their drinking is probably in one of the four stages of alcoholism. Negative Impacts on life areas include:

Family: Drinking is a source of conflict. Sensitivity to any mention of drinking by family. Family has left or threatened to leave over drinking. Family does not want to attend functions where drinking occurs. Family feels that the alcoholic loves drinking more than he/she loves them. Insensitive to the effect of his/her drinking on family members.

Legal: Has been stopped or arrested while driving intoxicated, even if not charged or convicted. Takes risk of driving after drinking. May drive drunk with kids in car. May be in other legal trouble due to belligerent or violent behavior when drinking, or simply because of irresponsibility (failure to pay taxes, etc.). Teens may be arrested for shoplifting alcohol, or for using fake ID to buy it.

Social: Plans ahead for drinking in social situations. Drinking is important part of most gatherings. Always describes fun times as including alcohol. Brags about how drunk he/she got or how good the alcohol was. Drinks before going to social situation. Has had difficulty remembering later what was said or done while drinking.

Health: Is concerned about effect of drinking on health. Doctor has mentioned drinking's effect on health or has encouraged to stop or "cut down." Has had any abnormal lab results related to liver, kidneys. Has stomach or intestinal problems which are worse after drinking. Has had bruises or injuries which cannot be explained or remembered.

Alcoholism is a progressive illness; without treatment it gets worse and worse over time. Although alcoholics are able to remain abstinent or reduce their drinking for periods of time, as long as they feel that drinking is an option they will almost always return to drinking eventually. Scientific studies, and much anecdotal information from recovering alcoholics, have shown that despite a period of sobriety, when an alcoholic returns to drinking, their drinking resumes at the level it would have been at had they never stopped.

Therapy for alcoholism requires emotional support, linking the alcoholic up with an appropriate recovery group (AA, Rational Recovery, etc.), referral for outpatient or inpatient detoxification (to prevent seizures if the alcoholic has been drinking heavily and steadily), and educating the alcoholic about the reasons for doing all of this.

Becoming and staying sober is perhaps that most difficult thing he or she will ever do, and it requires frequent contact with the therapist, a recovery group and sponsor, and with sober peers. Most of the time, family therapy is needed to repair years of damage done by the alcoholic's drinking.