I was surprised to read, while researching a post on addictive personality for AddictionNews, that the terms “alcoholic” and “alcoholism” are on the way out. This guidance comes from none other than George F. Koob, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

It’s very unusual for the director of an organization to reject something that’s right there in the name of the organization, so a closer look is warranted. Here is Dr. Koob describing the goals of the NIAAA:

Our mission is to provide evidence-based information about the diagnosis, prevention, treatment, and evaluation of alcohol use disorder and about the overall health consequences of alcohol.

Notice the phrase “alcohol use disorder,” or AUD. This is the preferred language for addressing this specific subset of substance use disorder, or SUD. Alcohol Use Disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and includes both alcohol abuse and alcohol dependence, the two alcohol disorders recognized in DSM-4.

Another term gaining traction is “unhealthy alcohol use,” which includes, for example, risky alcohol use that would not meet the clinical definition of AUD. The terms “alcoholic” and “alcoholism” imply a line being crossed. On one side you’re a responsible drinker and on the other side, a hopeless drunk. But there is no line, just a continuum of difficulties that alcohol use can cause in one’s life.

The problem with the terms “alcoholic” and “alcoholism,” according to an article in Psychology Today by Sarah Dermody, Ph.D., is that they impart a stigma. “Research has shown that fear of stigma is one of the top reasons people choose not to get treatment for substance use,” she writes.

If the terminology is an impediment to getting treatment, then Dr. Koob is right, it’s time to let the negative labels drop out of usage in favor of more neutral language.

Written by Steve O’Keefe. First published December 14, 2023.

Sources:

“Meet the Director: George F. Koob, Ph.D., National Institute on Alcohol Abuse and Alcoholism,” NIH MedlinePlus, June 2023.

“Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5,” National Institute on Alcohol Abuse and Alcoholism, undated.

“Moving Away from the Terms ‘Alcoholic’ and ‘Alcoholism’,” SmartRecovery Blog, April 2019.

“Should We Stop Using the Word ‘Alcoholic’?,” Psychology Today, April 2023.

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