Many of us know an uncle or cousin, or even an immediate family member, who had a “problem” with alcohol or other drug(s). As a psychologist, I have heard many opinions about why people have drug addictions and what should (or could) be done about it: Aunt Marge has a “weak” constitution and cannot control herself; Cousin Vern drinks too much, he is an alcoholic, or a lazy “good-for-nothing” loser. As we’ve written about previously, opinions and perceptions are important for interpersonal interactions. Perceptions of a partner’s drinking (or drug use, if you extend the logic) impacts relationship quality: if you believe your partner drinks (or uses) too much, then this perception could lead to dissatisfaction with your relationship with that person.
What contributes to these perceptions? What most people “know” about addiction is oftentimes based on personal experience or opinion, not on research. The current Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is used by medical and psychological professionals for diagnosis and treatment of mental health issues, describes substance abuse disorders along a vast continuum ranging from mild to severe. What people often do not understand is that an individual’s life needs to be significantly impaired across numerous life domains to be diagnosed with a substance abuse disorder. This impairment includes failing to fulfill major role obligations (e.g., work), having legal problems associated with drug use, and using drugs despite persistent social and interpersonal problems. In order to get even a “mild” diagnosis, there have to be at least two or three of 11 symptoms (e.g., physical dependence on the drug) present.1 In other words, moderate and even regular use of a substance such as alcohol does not mean a person has a drug addiction or that they are an alcoholic.
Many of the students I train to be substance abuse counselors start with the perspective that drug use is the same as drug abuse, and that people who regularly use drugs have an addiction. This perception is grossly inaccurate, as there is great variability in how much and how frequently people use drugs, their motives and level of dependency (if there exists any at all), their ability to control their impulses to use, and the impact their use has on other parts of their lives. Why do so many people hold these perceptions, even in the face of research and clinical perspectives that contradict them? Prior to the 1800s, most Americans drank alcoholic beverages and favored them over drinking water, which was oftentimes contaminated and unsafe.2 After the American Revolution in the late 1700s, alcohol became “demonized” in American culture, which led to the demonization of other drugs. People were encouraged to avoid alcohol entirely, resulting in Prohibition laws and abstinence-only substance abuse treatment philosophies. We know today that abstinence-only treatment programs are largely ineffective,3and yet even researchers examining stereotypes about drinkers have only started to examine perceptions of ‘moderate drinkers;’ previously they had an all-or-nothing or abstinence-only perspective: you drink very little, or too much.4
One romantic partner may perceive having two glasses of wine a night with dinner as “too much,” while another may view it as perfectly fine. It is important to understand the basis of these differing perceptions. If a partner views the other’s behavior as unhealthy, it is important to consider whether this is a bias drawn from socialization about the stigmatization of use of drugs or alcohol, or whether the partner actually meets the diagnostic criteria for a disorder. Only a trained clinician can make this latter determination, so professional help should be sought if there are concerns about a disorder. Otherwise, open communication about your biases and preferences, as well as what you both feel is normative, is important if your perceptions about drug and alcohol use are different from those of your partner.
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1American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2Hart, C. L., Ksir, C., & Ray, O. (2009). Drugs, society, & human behavior. 13th Ed. Boston, MA: McGraw Hill.
3Wolk, J. L., Hartmann, D. J., & Sullivan, W. P.(1994). Defining success: The politics of evaluation in alcohol and drug abuse treatment programs. Journal of Sociology and Social Welfare, 21, 133-145.
4van Lettow, B., de Vries, H., Burdorf, A., Norman, P., & van Empelen, P., (2013). Associations between abstainer, moderate and heavy drinker prototypes and drinking behaviour in young adults. Psychology & Health, 28, 1407-1423.
Dr. Jennifer Harman – Adventures in Dating… | Science of Relationships articles | Website/CV
Dr. Harman’s research examines relationship behaviors that put people at-risk for physical and psychological health problems, such as how feelings and beliefs about risk (e.g., sexual risk taking) can be biased when in a relationship. She also studies the role of power on relationship commitment.