I’ve always been a little uncomfortable when I hear the phrase “alcohol and drugs”. I’ve been around treatment long enough to know that alcohol is a drug. I’ve even joked before that alcoholics are simply addicts in denial about the nature of alcohol. I’ve heard a number of arguments in favor of keeping them separate…the primary being that alcohol is legal. I think the main reason we separate the two is that for the most part, alcohol is socially acceptable.
Now I’m not arguing that alcohol should be considered a controlled and dangerous substance. We tried that once and it obviously didn’t work. There are millions of persons who use alcohol responsibly with no significant problems or distress. No, I’m not suggesting we start to look at alcohol like we do other drugs; I’m arguing that we start to look at other drugs the way we do alcohol.
Just as there are millions who successfully use alcohol, many are able to “successfully” use illicit substances with no significant consequences aside from the legal risk. Should that use be called a psychological disorder? Should those who disagree with arbitrary societal controls be considered disordered? That’s a dangerous thought.
Not everyone who drinks alcohol is an alcoholic and not everyone who uses drugs is a drug addict. I’m hopeful that the change in the DSM-5 will eliminate some of those previously diagnosed only because of involvement in the criminal justice system. While criminal justice involvement is certainly a problem, it isn’t necessarily a substance use disorder (SUD). Many who currently meet the criteria for abuse may have decision-making problems but you’d be hard pressed to classify their behavior as a psychological disorder.
Hopefully the new diagnostic criteria for Substance Use Disorder will “purify” the diagnosis and only include those who are experiencing actual physiological, psychological, social or interpersonal distress as a result of their use.