“I have something to tell you,” Jolie said as she sat down in my office. “It’s really bad.” She went on to describe how she’d ruined a dinner with friends because she’d drunk two glasses of wine, gotten irrationally upset with one of them, and left before dinner was over. With a tone of mixed embarrassment and surprise, she remarked that she must have been drunk. But as I probed further, she admitted that she’d drunk “a little” before the dinner to take the edge off her day. And further probing revealed that her two glasses of wine were more like a bottle. As we talked more about when and how she drinks, she began to acknowledge that her use of alcohol was starting to cause problems she’d been unwilling to see.
Reluctantly, she acknowledged that drinking alcohol had become her automatic stress reliever when she got home from work. But what she was calling “having a glass of wine” really meant using a glass to consume a bottle of wine. She also relayed frequent incidents of being irritable at work in the morning, which her boss had commented on. She now wondered if her change in behavior was because of the amount of alcohol she’d been drinking after work. With a look of terror, she said, “I think I might have to stop drinking altogether, but do you think I’m really an alcoholic?”
The labels we use to describe clients’ behaviors have important therapeutic implications. In Jolie’s case, it was tempting to diminish her fear and say, “Well, let’s not label this as alcoholism yet.” After all, her drinking hadn’t led to car accidents, bar fights, bouts of lost consciousness, or lost income. But I was reluctant simply to call her drinking a habit, because that would diminish the seriousness of it and imply to her that it was something easier to change than addiction. Although Jolie’s use of alcohol had indeed become habitual, both in the colloquial and neurobiological sense of the word, she was exhibiting signs of addiction: loss of control over how much she drank and how she acted.
Of course, drinking to calm down, feel relaxed, and add some pleasure to an evening is a common use of alcohol, and by itself it doesn’t constitute alcoholism. But when it becomes the only choice to calm down, addiction is an issue. As therapists, we know that compliance with treatment is the biggest obstacle we face in planning recovery. Sometimes using the word addiction and explaining its neurological basis can help clients focus on the consequences of their behavior and carefully plan how to change their self-destructive patterns.
But how do we parse the tenuous line between addiction and habit?
Read Symposium 2014 presenter Margaret Wehrenberg’s complete article, “Habits vs. Addictions: What’s the Difference?,” in the November/December 2013 issue of Psychotherapy Networker magazine.