Dear Richard Velleman,
Re: https://www.hifa.org/dgroups-rss/alcohol-use-disorders-125-how-can-we-de...
Thank you for confirming that there are multiple definitions of alcohol use disorders 'because different organisations DO focus on different issues – for example, some may focus on physical health and harms to health, others may focus on social problems, some on criminal justice consequences, etc'.
Your own perspective - "Someone has an alcohol problem if their drinking causes them or anyone else a problem” - is persuasive. Indeed it cannot logically be refuted. This deines an 'alcohol problem' but how would you define 'alcohol use disorders'? In the same way?
You mention WebMD's definition - 'Alcohol use disorder (AUD) is a chronic illness in which you can’t stop or control your drinking even though it’s hurting your social life, your job, or your health' - as reflecting an outdated binary conceptualisation. But I find this definition also is persuasive, and adequately embraces (nearly) everyone who has, in your definition, 'an alcohol problem'.
You give the amusing example of a person who has one pint of beer and this becomes a relationship problem because the spouse is a teetotaller. Whether this is 'alcohol use disorder' depends on the context. If the person cannot 'control' their one pint a week while knowing that it is causing a problem in the relationship, then at a stretch this could be an alcohol use disorder. It sounds more likely that the problem is related to spousal intolerance and/or a deeper problem in the relationship.
"It means that whether or not someone has a drinking problem is not determined by fixed quantities of alcohol, or fixed timings, but instead is a matter of negotiation by the individual with him or herself, family, friends, work place, and society as a whole."
Very often, people may be drinking more than is healthy for them, predisposing them to cancers and other chroic illnesses later in life. But not so much as to be even recognised as an problem by themselves or others. I would see this situation being 'covered' adequately by the WebMD definition. The person cannot fully control their drinking (it has become a habit) and it is hurting their (long-term) health.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
