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[Sappho]

I keep hearing that alcoholics (that is, people who are physiologically addicted to alcohol regardless of how much they drink - not people who simply drink a lot or all the time) can never be "moderate" drinkers. That because of their body's reaction to alcohol, once they quit, they can never have another drink again.

I've also heard seen some more recent articles suggesting that some alcoholics can actually drink in moderation if they're careful, though ones who used to be heavy drinkers probably can't.

I always heard that the reason an alcoholic can't even have one drink is that the one drink will immediately restart the addiction, and if they, for example, have a single drink and then want to stop again, they have to go through some form of withdrawal again. But now I'm wondering if that's misinformation, and the reason people say alcoholics shouldn't start drinking again is because of the danger that one drink will lead to more and they'll wind up drinking too much.

So my real question is, if an alcoholic who has never been a heavy drinker (averaging 1-2 drinks per day for some years) eventually realizes that despite their moderate drinking level, they are addicted, quits, and goes through weeks of withdrawal, later wants to have an occasional drink, will they have to go through that withdrawal again? Or are they fine as long as they don't drink too much or too often? Assuming that they have the willpower to do so.

[Orange Wizard]

I'm not an expert so [citation needed], but AFAIK the latter is true. If you've broken the addiction, you should be able to drink without any negative effects (barring those usually associated with drinking). Withdrawal symptoms shouldn't appear unless you get back into the addictive cycle.

[lordcooper]

My uncle was an alcoholic for many years.  He has a drink or two on special occasions now.

I think it's just a matter of self control at this point.  An alcoholic is likely predisposed towards alcoholism on some level and might well experience mental cravings/desire to start drinking again after a tipple, but you're not going to go through physical withdrawal again if you chug a few pints on occasion.

Edit: As always, consult a doctor if you have concerns though

[Sappho]

Thanks for the responses so far. I am asking for myself, so I can give firsthand information. For maybe ten years I had one or two drinks almost every day. I didn't think I could be an alcoholic because, like many people, I thought that was synonymous with heavy drinking. Turns out that's not true - the real meaning is that your body doesn't metabolize alcohol properly and you become instantly dependent on it the first time you have a drink. You can't "become" an alcoholic - you are born with this genetic issue. The reason I realized I was one was that when I have one drink, I immediately crave more. The more I drink, the more desperately I want more. Generally I only buy 1-2 beers per day, so I don't have any more at home, and I don't want to go back out to buy more. I also have extremely strong willpower, so when I decide not to have more, I simply stop drinking and endure whatever ill effects come from that. But at a party, when it's expected that everyone will drink, I find myself downing 10 beers in a night (and I'm a small person) and making myself sick for days. I definitely don't want to do that anymore.

When I stopped, 6 weeks ago, I had two weeks of horrible withdrawal. I even had to miss a few days of work. That confirmed the fact that I was addicted. Then the worst of it passed, but I don't feel better. I'm autistic with severe hypersensitivity problems and alcohol is still the only thing I've found that dulls some of that sensitivity. I'm now in increasing pain every single day as the world gets louder and brighter and just more awful. I'm less productive at work. I don't even have the energy to play video games, I'm so exhausted and worn-out. And that is not a good sign.

I waited a full month, expecting that this was all part of the withdrawal and it would ease once the alcohol was out of my system. But the fact that after 6 weeks it's still only getting worse tells me that alcohol is not the reason. This is how I always felt when I was growing up, before I discovered alcohol, and alcohol may be the only "medication" I can use to get myself functional again. Like any medication, it's dangerous and addictive and has side effects, but I don't know what other solution I can find. I already know I can't take any kind of antidepressants because I get psychotic mania from them, and I really don't want to have to take Lithium (never mind the fact that my insurance wouldn't pay for it).

I was functioning just fine on about 2 beers per day. I would like to drink less than that. But my fear is that if I have a beer one day, then I don't drink the next day, I'll feel horrible the day after that. In fact, that's what always happened before (another reason I realized I was addicted - missing a single day of alcohol caused some withdrawal symptoms). But it would be the same with a prescription medication, I guess. If this is the only thing that works, maybe I *should* drink. As long as I don't allow myself to drink more and more and wind up a problem drinker.

It's difficult, because everyone around me hears the word "alcoholic" and immediately insists that I must quit cold turkey and never touch alcohol again. I feel like I'm in that old film Reefer Madness. The boogieman of alcohol is out to get you! It will ruin your life if you ever touch it again!

[Orange Wizard]

To be fair, there probably is some medication that'd be a better alternative to alcohol. Not that it sounds like that was bad to begin with, so vOv.
Anyway, if it's a major issue, you should be getting advice from a proper doctor. We're just the budget armchair variant.

[Jimmy]

Would you have experienced three or more of the following during the last 12 months:

• You need a large quantity of alcohol to feel intoxicated.
• When abstaining from alcohol or cutting down, you experience tremors, insomnia, nausea or anxiety.
• You end up drinking more alcohol than you intend or drink for a longer period than intended.
• You continuously try to cut down alcohol consumption but fail to succeed, or have a persistent desire to cut down.
• You spend a lot of time obtaining, using or recovering from alcohol consumption.
• You withdraw from recreational, social, or occupational activities you used to enjoy before drinking regularly.
• You carry on consuming alcohol even though you know it is harming you physically and psychologically.

If so, you meet the American Psychiatric Association's definition of alcoholism. However, there is no currently accepted definitive diagnosis tool that identifies those suffering from alcoholism. In general, if your drinking is affecting your quality of life, it is likely problematic.

Should you be sure you are an alcoholic, the safest option is to avoid drinking altogether. The body doesn't need alcohol to survive, and if it has the potential to cause you serious harm, you would be better served to abstain. If you are suffering from depression or self medicating with alcohol, speaking with a qualified doctor about alternative treatments for your condition would be a far safer option.

To use an example, imagine that you enjoyed extremely physical sports, such as rock climbing. You then discover that you have a genetic condition that causes you to have weak joints prone to dislocation under strain. After being injured several times you take a break and spend time healing until you feel better. If you were to go back to rock climbing, there's a high risk that you could be injured. You could try to limit yourself, but there would be a strong temptation when you are in the middle of rock climbing to push your limits again. The safest option is to find another activity you enjoy that doesn't expose you to the same risk of permanent harm.

Drinking alcohol shouldn't be something you feel a need to engage in doing. It's not so much a question of "Can I drink?" Instead, it's a question of "Should I drink?" If you know it causes you harm, why would you go back to it?

[Sappho]

Jimmy: if you read my second post, I explain my reasons for considering starting drinking again. Since it was never a "problem" to begin with, and I know I have plenty enough willpower and support to drink only moderately, I'm not concerned that it will really cause me any serious damage. And I have an unusual reason to do it: I suffer from extreme hypersensitivity. "Extreme" meaning I am in pain every second of every day, just due to normal light and sound that other people would never even notice. This isn't psychological: my nerves are physically more sensitive (and more easily damaged - I have tinnitus despite a lifetime of avoiding loud noises). Drinking one beer a day seems to be enough to reduce the hypersensitivity to a level I can manage, so that I can work and be social. Since I've stopped drinking, I have been suffering at a horrible level. I'm in such pain all the time, I have to wear ear protectors just to leave the house (and often even in my own apartment, where others would consider it to be "silent", but even the sound of the refrigerator humming is painful). I can't socialize. I can hardly get my job done. And it's getting worse every day, even after 6 weeks of total abstinence.

I have actually discussed treatment for hypersensitivity with doctors in the past. One suggestion was antidepressants, but when I tried those (several different types), the results were horrific. I suffered from psychotic mania: I hallucinated I was delusional. The doctors agreed that I am a type of person who cannot take antidepressants. It was suggested that I could try lithium, but the side effects of that can be extremely dangerous, and it's far more addictive than alcohol. Alcohol, in fact, is far safer than lithium, as long as I don't drink to excess. It's also a lot cheaper. According to the doctors I spoke to, there is no other treatment for hypersensitivity. It's a relatively rare condition and since most sufferers are able to manage their lives on their own, it's not something that anyone is researching a treatment for.

I have three problems with seeing a doctor. The first is that my insurance won't cover a visit to a doctor for this problem. The second is that there are relatively few English-speaking doctors here, and those who do speak English are generally very expensive. The third is that a doctor with experience with alcoholism generally does not have experience with autism. I've found consistently that no matter what type of doctor I see (GP, neurologist, psychiatrist, etc.), they don't understand anything about autism beyond the misinformation most people in the general population have. When I try to explain the problems I have, they accuse me of making it up or being a hypochondriac, because they've never encountered it before. So I'm 95% sure that a visit to a doctor with my current question would result in "you're an alcoholic? Then you must never touch alcohol again." "But I'm autistic and hypersensitive and I don't have any other way of managing my pain." "We can put you on antidepressants if you want..." It's a broken record that I'm frankly tired of hearing. When it comes down to it, doctors simply don't know how to help me.

I know you guys aren't doctors or experts, but by posting here I'm mostly hoping to find at least one or two people with firsthand experience with alcoholism (particularly when the alcoholic was never a "problem drinker" and only drank moderately) who can tell me whether there might be problems from an occasional drink (ie immediate withdrawal problems). It sounds like if I keep my consumption below a certain level, I shouldn't have a problem with withdrawal on the days I don't drink. But it also sounds like if I drink every day, I will probably have to deal with withdrawal symptoms if I take a day off.

So my current choices seem to be:
1. Continue abstaining from alcohol. Suffer. I suspect that if it continues to worsen at the current rate, I will eventually no longer be able to work or participate in social activities at all. I will be fully disabled. If I can't earn a high enough income, I lose my visa and will be deported. I'm 30 years old, single, and want a family, and I can't meet new people without being able to tolerate the noise and bright lights of social settings, so I will eventually have to settle down with a herd of cats and wonder if maybe it wouldn't have been so bad to drink a beer a day. If all this sounds extreme, I assure you it is absolutely the truth. This is the reality of my life, and it's why being autistic is widely considered a disability.
2. Start drinking again, but infrequently. It would take some experimentation to figure out how much I can have without triggering withdrawal, and whether that amount is enough to keep my sensory overload at bay. Basically, I don't know what the results would be unless I try it.
3. Start drinking again, and treat the alcohol like a dangerous and addictive medication that must be managed carefully. Measure my intake - presumably one drink a day would be enough. Like any medication, take it at the same time every day and don't allow myself to take more under any circumstances. Accept that, just the same as if I were on a medication such as antidepressants or lithium, if I ever decide to stop or miss a dose, I will suffer withdrawal. Do NOT drink extra in social situations, no matter how much everyone else is drinking.

At the moment, 3 is sounding like the most logical choice. Alcohol is a drug, like any other. And drugs can be good or bad depending on how they're used. Most drugs used for constructive medical purposes have side effects and dangers. Choice 1 sounds more and more ridiculous the more I think about it - unless I can find an alternative treatment for hypersensitivity, refusing to drink just because of the social stigma that surrounds alcoholism would just be stupid. Choice 2 might be something I can experiment with, but it seems to me that the only way the alcohol can consistently help me with hypersensitivity is if I use it consistently. Antidepressants don't work if you only take them sometimes, either. And in fact, if I only drink infrequently, there's the danger that since it's not a routine thing, I might overindulge at times, which I want to avoid.

[Orange Wizard]

Option 3 does sound like the most logical course of action. Probably what I'd do in your position.

[Harry Baldman]

Alcoholism is defined by poor impulse control and being a 'problem drinker'. An addiction becomes medically relevant when it introduces a noticeable decrease in quality of life. For instance, in cases where you skip work to get shitfaced or ignore other responsibilities due to the same. If it's not causing negative consequences, it's not really a medical disorder. And if you do have strong willpower and a lifestyle (family, friends, workplace situation) that does not enable dysfunctional behavior, you're not at particular risk of being a proper alcoholic to begin with.

On the other hand, you do seem to be using alcohol to provide relief. That's all fine and good, but strikes me as a slippery slope. Self-medication is a risky undertaking since your mind and body can and will lie to you if given half the chance.

The reason the standard form of advice for alcoholics is to stay away from booze forevermore is that an addict can rationalize their way into basically anything, and if you give an inch a mile may often be taken. This need not be the case with you, naturally. And probably won't be if what you say is honest and on the level. Not to cast aspersions, of course, but alcoholics as well as other types of addict are famous for lying shamelessly to hide or rationalize their habits. Granted, it's not like any of us can legitimately check your background to see if you are being entirely truthful rather than merely phrasing your issues in a way that makes Option 3 the most logical answer in order to seek validation for what you're about to do.

I wouldn't really trust the opinion of forumites who don't actually know you on a question this personal, truth be told. If your support network is as good as you say, ask your loved ones. They'll be the ones to know when and if you become less functional, in which case you will want to take steps to remedy your situation. Once again, functionality is key.

[Shadowlord]

3 does sound most reasonable.

When you say your body doesn't metabolize alcohol properly - do you mean before it gets into the blood ("Women metabolize about 10% of the alcohol ingested, while men metabolize about 30%.") or in the liver (e.g. Alcohol flush reaction)?

Phone battery dying, sorry.

[Thief^]

The biggest problem with alcohol addiction is that avoiding drinking is largely an act of willpower, but alcohol itself is a willpower reducer. Coupled with the fact that drinking is socially acceptable, if a former alcoholic gets persuaded to have even one drink their willpower can break down to the point of having a dozen. A lot of drink when you're body is no-longer used to it can be deadly.

If drinking alcohol wasn't socially acceptable (like smoking now isn't) then it would be a lot easier to stay quit. The biggest problem for addicts of any type is their friends and family pulling them back in. "It's just one, right?" "It's a special occasion!" "Let's do it again on Friday!" "Are you about Wednesday night?" "See you again tomorrow..."

Regarding option 1: I can't drink personally. ~two drinks leaves me sobbing on the floor in serious depression. I also intensely dislike "social situations", they scare me (a mild phobia of something? I've never pinned it down). As a result I abstain from drinking, and don't frequent pubs. I am now 30 and have a family. Not drinking or frequenting that kind of social events is not an obstacle to meeting someone special, there are other social situations that aren't the big noise, bright lights, big drinking parties. The best way to meet someone you want to settle down with is in real life. You know, normal day-to-day stuff. Not a special place, or special event.

Failing that, seriously consider internet dating. The best sites are full of people who genuinely want a relationship rather than the short-lasting fling that starts at a typical social event. How many couples say "well, we met in the pub"? On the other hand, 17% of recent marriages started with an online date (US statistic).

[Sappho]

Alcoholism is defined by poor impulse control and being a 'problem drinker'. An addiction becomes medically relevant when it introduces a noticeable decrease in quality of life. For instance, in cases where you skip work to get shitfaced or ignore other responsibilities due to the same. If it's not causing negative consequences, it's not really a medical disorder.

I think you're confusing alcoholism and problem drinking there. You can be a problem drinker without being addicted to alcohol, and you can be addicted to alcohol even if you rarely drink. Alcoholism is a genetic problem. It's identifiable by how you react to alcohol: if one alcoholic drink causes you to crave more, you're an alcoholic. If you drink way too much, because you want to be drunk, because you are depressed, because you think it's fun, etc., you may be a problem drinker, but not necessarily an alcoholic.

Shadowlord: I honestly don't know much about the specifics. Actually, I just went back and re-read where I had thought I saw that, and it turns out I remembered the wording wrong. The actual wording was "Alcoholics become addicted because their bodies are physiologically incapable of processing alcohol normally." It's a quote from a rehab site. That same site also says an alcoholic can't have a single drink ever because they will start drinking too much, but I have read elsewhere that more recent research points to it being perfectly possible for an alcoholic to drink in moderation as long as they have the willpower and support to resist the urge to drink more.

Thief: I understand that it's possible to meet people through normal activities. The problem is that ANY normal activity is too painful for me to engage in due to my hypersensitivity. I didn't mean to suggest that the only way to meet someone is to go out to places with alcohol: what I meant to say is that without drinking regularly to dull my hypersensitivity, I am unable to frequent *any* type of social situation. I can't go to a cafe for a cup of tea, a book club, an art class - nothing. Simple, normal interior lights are painful on my eyes. The sound of quiet footsteps hurts my ears. I can barely even handle going to work. Right now, the noise of the keyboard as I'm typing is so painful I can hardly tolerate it. It's like knives stabbing me in my ears. I can't do anything but hide at home with the lights turned off and my ear protectors on. Anything else is too painful to tolerate.

Sadly, meeting someone is extra-hard for me. Aside from being autistic, I live in a country where most people get married and have families early (so there aren't too many single people left by my age). I also need to find someone who can fluently sign. Speaking at home is too hard for me - I prefer sign language. So now I'm narrowed down largely to deaf single men in their 30s in Prague... And that's a pretty small group. I'm hopeful that I'll find someone, but I certainly can't find anyone when I'm hiding at home alone in the dark. I need to be able to go out and be social to some degree. (And sadly, online dating is almost nonexistent in this country, since people settle down so young, otherwise I would agree that it might be a good thing to try - on the other hand, there's a HUGE porn industry and a some people post fake date ads which turn into porn shoots, and I'm not taking that risk!)

In any case, I've made my decision. I will start drinking again, but in carefully controlled amounts. I talked it over with a friend today and he said he thinks my reasoning makes sense. He knows me well enough to confirm that my willpower is strong enough to stick to one drink per day (in fact, he's commented on my willpower before). He will be supportive in keeping an eye on me, and I know my other friends will too. I have suffered enough, and it's been long enough that I'm convinced it's not going to get better in any other way. I really think it will be okay this way.

Now I'm going to get the beer that's been sitting in my fridge for 6 weeks and finally open it. (I think if I can go 6 weeks of suffering with relief so readily available and not even come close to touching it once, I'm probably safe in terms of willpower.) Wish me luck, everyone! I plan to enjoy it.

[ancistrus]

Didnt read everything here.

But how does one become an alcoholic? There is no clear line between a semi-heavy drinker and an alcoholic. Or maybe there is, but you don't realize that you have crossed it - you only realize you are an alcoholic once things are really bad.

So, if you are an alcoholic, that stopped drinking and then started again, will you be able to judge what is ok and what is not? After all, you have failed once already.
If you drink a single beer, have you screwed up?
If you drink 10, but it happens once in a few months, is that screwing up?
There is always a way to rationalize your drinking, to convince yourself that you are OK. A person who has learned this lesson might conclude that it is safer to just not drink at all, period.

[Sappho]

Didnt read everything here.

But how does one become an alcoholic? There is no clear line between a semi-heavy drinker and an alcoholic. Or maybe there is, but you don't realize that you have crossed it - you only realize you are an alcoholic once things are really bad.

So, if you are an alcoholic, that stopped drinking and then started again, will you be able to judge what is ok and what is not? After all, you have failed once already.
If you drink a single beer, have you screwed up?
If you drink 10, but it happens once in a few months, is that screwing up?
There is always a way to rationalize your drinking, to convince yourself that you are OK. A person who has learned this lesson might conclude that it is safer to just not drink at all, period.

Most of this has been answered several times already, so if you want to participate, I encourage you to read my other posts rather than me writing it all again.

[Harry Baldman]

I think you're confusing alcoholism and problem drinking there. You can be a problem drinker without being addicted to alcohol, and you can be addicted to alcohol even if you rarely drink. Alcoholism is a genetic problem. It's identifiable by how you react to alcohol: if one alcoholic drink causes you to crave more, you're an alcoholic. If you drink way too much, because you want to be drunk, because you are depressed, because you think it's fun, etc., you may be a problem drinker, but not necessarily an alcoholic.

Alcoholism is problem drinking. That's literally what alcoholism is, in fact. Genetic factors may predispose you to alcoholism, but the disorder as such manifests as problem drinking.

Though if you can point me to any scholarly literature that says otherwise, I'd certainly appreciate it.

EDIT: I mean, I've heard the term "alcohol abuse" used before as well. That seems to fit what you consider a problem drinker, the difference between an alcoholic and an alcohol abuser being that the alcohol abuser can theoretically stop without repercussions, but is simply unwilling. They're usually filed with alcoholics, however, since the result is largely the same and it's quite difficult to tell the difference (either way you can't stay off the sauce) given the thin line between psychological and physiological addiction. It's still called alcoholism most of the time as a result.

Granted, moderate drinking is probably underreported clinically because it's not really a clinical problem if it's moderate. Not that you likely could explain it to a doctor if you had it anyway, since admitting yourself to be an alcoholic compromises your testimony and it's so much more convenient to file you in with the average alcoholic than as, say, a special case requiring unusual expertise. Where that leaves us in terms of useful advice - while I do know my fair share of alcoholics, about half my family tree being such, can't say I know much about the specifics of their joneses, so to speak, and for most it's likely the same way - is unclear, but I'd say that your description of alcoholism is not really in line with what is commonly understood as alcoholism.