Too young and smart to be an alcoholic

I suppose the language we use to describe alcohol and drug problems will continue to evolve, but I hope the language evolves toward clarity nor obscurity. As I wrote a week or so ago, there are many old ideas about alcohol and drug problems that persist in spite of all the things we know about alcohol/drug misuse and addiction. Calling someone an alcoholic or drug addict has become derogatory, so, many therapists now use the new terms – Alcohol Use Disorder or Substance Use Disorders.

I don’t know if this is an improvement. It all depends on how we think about alcohol and other drug problems. If we look at addiction as a chronic brain disease that progresses in stages, then it really doesn’t matter what we call it, as long as we understand what it is. It’s particularly difficult, even for many therapists, to call someone young, smart and from a good home an alcoholic or drug addict, or to say they suffer from substance use disorders.

When, say, a smart, young female from an upper middle class or wealthy family presents with a history of heavy drinking, most therapists will look for the psychological cause of the heavy drinking — they see a smart, young female who must be terribly bothered by something in her life to drink this much. Most people will think she is too young and smart to be an alcoholic. The therapist thoroughly trained in addiction treatment with plenty of direct experience dealing with alcoholics and drug addicts will first rule in or rule out addiction, because they know that addiction doesn’t pick and choose among classes or age or gender or intelligence. The addiction specialist also knows that addiction can develop and progress without any underlying trauma or emotional disorder that’s causing the heavy drinking — it can be as simple as the person started drinking and is susceptible to addiction and is now in the early stages of addiction. Among all the therapists who see clients such as the one described above, few have been thoroughly trained to recognize and treat addiction.

Young females like the one above will likely go through a few months of counseling once a week. Although the therapist will surely talk to them about their drinking, the discussion will often relate to risk involved in heavy drinking, thus the implication that drinking in moderation is good and heavy drinking is risky. But, the main focus of the therapist will likely be, with the cooperation of the client, to deal with the underlying mental and emotional problems so that the heavy drinking subsides when the young female is mentally and emotionally healthier after the counseling sessions and has seen how the heavy drinking is dangerous and unhealthy.

If the young female is, indeed, drinking heavy because of some unresolved mental/emotional problems, then the counseling can generate positive change — however, if the young female is in the early stages of addiction, chances are the counseling will have no positive, lasting effect on the addiction problem. In a short while the young female’s addiction will continue to progress and the problem will get worse. This is how addiction continues undetected for years with many people. If the person presenting for an assessment doesn’t look the part, then it’s difficult for most therapists to call addiction for what it is. There are also philosophical differences, and many therapists don’t really buy into the chronic brain disease concept of addiction. This is unfortunate, because the science is on the side of chronic brain disease.

Young people don’t die from many causes, but the number one cause of death among young people is related to alcohol and drugs. No teenager or young adult is too young and smart to be an alcoholic. If a young person is showing signs and symptoms of an alcohol or drug problem, addiction/substance use disorder should be ruled in or out by a well trained addiction specialist. The consequences of inattention and denial are too great.