Measurement of drinking, alcoholism, and the loss-of-control phenomenon

Abstract

The behaviour of drinking alcohol in its normal and abnormal aspects was considered in relation to the global concept of the disease of alcoholism. The diagnosis, "alcoholism", represents a social judgement about the degree of severity of the social and personal effects of alcohol consumption rather than a statement about drinking per se. The first two experiments were concerned with the direct measurement of drinking behaviour and a description of normal and abnormal drinking in terms of the parameters of consumption of alcohol by diagnosed alcoholics and normal, social, drinkers. Differences between these normal and abnormal groups were found to be statistically significant on measures of total alcohol consumed, rate of ingestion (speed of drinking) and mean sip-sizes in the consumption of both beer and spirits. The drinking patterns exhibited were similar to those reported in similar baseline drinking studies involving North American drinkers. A study of the individual patterns of consumption showed that abnormal drinking as defined by such behavioural profiles was not limited to the subjects already diagnosed as alcoholics. Conversely, all of the alcoholic subjects taking part did not qualify as abnormal drinkers on the basis of their drinking during these experiments. The concept of loss-of-control over alcohol, basic to the traditional view of alcoholism, was examined, and a behavioural definition of the pattern of drinking that this concept implies was described in Experiment 3 in terms of the units of measurement outlined above. Loss-of-control as a progressive increase in sip size, quantity of alcohol ingested etc., over the experimental period, also occurred for the normal drinkers but to a lesser degree than in the case of the alcoholics. In experiment 4 using mean sip-size as the dependent measure, experimental instructions were found to be equally effective in controlling the consumption of so-called loss-of-control drinkers (alcoholics) as they were for controlled drinkers (normals). In the final two experiments, non-alcoholic drinks were used in mock tea-taste sessions which alternated deprivation and preloading experimental conditions. A differential pattern of consumption was recorded for alcoholic and normal drinkers. The normal drinkers drank significantly more of their total consumption when deprived, whereas the alcoholic drinkers drank similar quantities whether deprived or preloaded. Imposing a "drinking in company" condition on this baseline affected the normal drinkers consumption making it more like the alcoholics’ consumption, but had no effect on the alcoholic consumption. The major findings suggest that the term "alcoholism", which incorporates a disease entity, is misleading, in that alcoholic consumption differs only in degree from normal consumption, and that the concept of loss-of-control over alcohol is based on a misunderstanding. The differences found between normal and alcoholic drinking are evidence for differential control functioning in the alcoholic drinker, rather than any lack of control.