Alcoholism vs. Addiction

How much do alcoholics and drug addicts really have in common? Our experts explain the similarities as well as the differences.

By Kristen McGuiness
Originally published on The Fix

“When I first got sober, I remember going to AA meetings and identifying as an alcoholic and an addict,” explains Douglas, a 37-year-old property manager from Dallas who’s seven years sober but has the graying temples and sun spots of an older man. “But then my sponsor told me that if I was going to identify as both, I better put two dollars in the basket: one for each. I got the feeling that I had to choose between them – that I was either an alcoholic or an addict, but I couldn’t be both.”

Patty, another member of Alcoholics Anonymous, says, “There’s almost an unspoken taboo in AA where you’re not supposed to talk about drugs or refer to yourself as an alcoholic and addict.” With only two years of sobriety, Patty, who has blonde model looks and an easy smile, admits that she’s just as judgmental as the next person. “I can tell there’s a resistance because I think the same way,” she admits. “I snicker when someone identifies as an alcoholic and addict, but the fact is that everyone in that room is an addict—they’re just addicted to alcohol.”

And modern science agrees. As Dr. John Sharp, an addiction-focused psychiatrist who specializes in the integration of mood disorders and addictions, says, “Alcoholism is an addiction – it’s just one type of addiction. When you break out the specific things that someone who is suffering from alcoholism contends with – impaired control, preoccupation with a drug, using despite adverse consequences, distortions in thinking, most notably along the lines of denial—they are no different from any other type of addict.”

Sharp explains that the definition of addiction – a topic The Fix has covered at length – has been even further tweaked. “Recently, the American Society of Addiction Medicine came out with an updated definition of addiction, which identified five other aspects: inability to abstain consistently, impairment of behavioral control, cravings, diminished recognition of significant problems, and dysfunctional emotion responses. I think it’s fair to say you can apply those aspects to both drug users and alcoholics.”

Either way, when someone’s brain reacts in an addictive way to one substance, they will no doubt act that way to any substance, which is why so many struggle when they quit one drug only to pick up another. For many heroin addicts, alcohol is their way out of their primary addiction. For others, it might be marijuana. But at the end of the day, for many addicts/alcoholics, it all becomes the same. As Douglas, the Dallas alcoholic/addict, says, “I can be addicted to anything: women, booze, meth, cigarettes, food. The fact that I call myself an alcoholic is really just so that I can relate to other alcoholics. We’re all the same when we say that. I’m no more different or special than the drunk next to me, and chances are, we’ve both been addicted to drugs.”

Are Alkies Really Different Than Addicts?

Says Jan, a 45-year old school teacher from California who realized she was an alcoholic after years of coming to class drunk, “I always figured that there are different types of Anonymous organizations so we have the ability to connect to other people’s stories, but whether its gambling or sex or booze, addiction creates the same obsession of the mind and the inability to remove yourself from the addiction when you’re in it.”

According to addiction psychiatrist Dr. Reef Karim, she’s right. “There is no clinical term for addiction,” he says. “It is more of a pop culture term than a scientific one. The true definition is substance use disorder, which can be anything—meth, cocaine, alcohol. And then there are non-substance use disorders, which could be sex, gambling or porn. We define all of it as addiction. What’s the difference between alcohol and addiction? Words. Addiction describes the brain changes and behavioral changes that create consequences in your functioning.”

And for many alcoholics and addicts, these changes are the same. Jan identifies solely as an alcoholic but she realizes that her addiction looks no different than the heroin user sitting next to her in a meeting. “I think the reasons for having an addiction are the same,” she says. “We’re all trying to fill that same hole, that same void, with outside things. I do think that different addictions mean different effects on the brain chemistry and different chemicals affecting the body, but at the end of the day, we are both battling the same disease.”

Dr. Karim concurs, explaining how different drugs can affect the physiology of a substance user differently. “Each drug has its own specific challenges and battles,” he says. “When you’re looking at meth, there is a really strong neurotoxicity for the brain. Meth addicts not only have impairment but they can destroy neurons in the brain. With cocaine, there is more of a cardiovascular problem. One of the biggest troubles with alcohol is actually cultural. It is a social lubricant, and it is really big business. That’s why it’s everywhere. You can work an AA program, and do therapy, and get medication, but there are going to be triggers everywhere with alcohol. People go to bars all the time; they don’t go to crack houses.”

For Douglas, alcohol ultimately became the deadliest addiction. “There were times when I put down the hard drugs, and that’s when it really got scary,” he confesses. “Alcohol compromised me in ways that cocaine, and even meth, never could. It turned me into a different person—one who made decisions that the sane and sober Douglas never would. And I would think, ‘It’s only booze.’ But booze for an alcoholic is just as dangerous as crack.”

Dr. Sharp agrees. “Alcoholism shows up like all addictions do,” he says. “The only difference is that alcohol is more prevalent. It’s the most widely used drug in the world, and it’s a normal part of many cultures. But people who are vulnerable to addiction run into trouble with it in the same way they would run into trouble with substances that they might need to reach out for more, like illegal drugs which aren’t as widely available.”

For Patty, ultimately it didn’t matter whether she was battling booze, Vicodin, or an eating disorder. “Addiction is addiction,” she states. “I have bulimia and it’s been just as hard to recover from as it has been to recover from alcoholism, and recovering from pills is just as hard as recovering from drinking. It’s all fucking hard. Ultimately, as long as we think the drug or the behavior will make us feel better, it will always be difficult to find recovery or abstinence.”

“Both addicts and alcoholics have a disease that’s impacting their brain from a reward circuitry standpoint by telling them that drinking or using is a positive behavior,” says Kirim. “And there’s probably something else going on—like an anxiety or a spiritual problem. But then you also have the direct affect of the drug on the brain. So in one way, you’re dealing with one drug /alcohol disorder in terms of its causes but then you’re also dealing with two different disorders in terms of their consequences on the brain and the body.”

Douglas has seen the different effects of both, but believes it’s all one disease. “There are many alcoholics who become addicted to other substances, and there are a lot of people who are addicted to drugs and when they stop the drugs, they become addicted to alcohol,” he says. “I almost wish that Bill Wilson had defined himself as an addict, too. I don’t think the disease is selective to the substance; some people just have a preference for the type of escape they like to have.”


20 Responses

  1. Hilary J. says:

    Excellent article, thank you! My life experience has taught me that addiction is addiction, whether to alcohol, drugs, gambling, food, etc. It’s the same problem with the same solution: the Steps and the support of the Fellowship.

  2. Wisewebwoman says:

    Great essay. I will never forget a busload of us going to Founders’ Day Weekend in Akron Ohio from Toronto over twenty years ago. About 50 of us.

    We had booked into a private room for dinner at a restaurant and one of the gang threw this out on the table during the meal:

    OK, we all have at least 5 addictions. Does anyone object if we all talk here about the other 4 or more?

    It was the most enlightening and open and honest “AA” meeting I was ever at. For two hours we all shared our other addictions, some of them crippling even though the alcohol and drugs were absent.

    And I’ve carried this with me in understanding and tolerance and acceptance everywhere since.

    Alcohol and drugs, the bride and groom, have many bridal attendants.

  3. Lenny says:

    I was an alcoholic for years, and a garbage can for whatever drugs crossed my path before I ever started shooting heroin, which is what ultimately laid me low. And the last substance I used before entering treatment was alcohol. When I first got clean in this rather small community, AA meetings were pretty much all there was. I sometimes looked around the room at my friends and knew from their stories that they were almost all just like me – drugs were a major part of their story. Rare was the person who was solely addicted to alcohol.

    As more NA meetings opened up, I gravitated toward them, primarily because they are less overtly religious and also because their language identifies the problem as addiction rather than a particular substance. My first sponsor, who I found in the rooms of AA, is still my sponsor, although he sticks with the AA crowd unless I drag him to an NA meeting for a special occasion.

    I get just as annoyed at NA members who get mad at people for saying “sober” as I do AA members who tell newcomer junkies to get lost. The awareness and knowledge of what language to use at whatever meeting one attends comes with time, experience, and recovery. Chasing a newcomer out the door is never the answer.

  4. John L. says:

    There are some good points in this article, but I don’t agree that there is a generic addictive personality. Addiction to alcohol is not the same as addiction to heroin, cocaine, cigarettes, slot machines, or shoplifting. Recovering alcoholics need the support of other recovering alcoholics.

    • Collie says:

      I disagree. If one looks at the similarities one finds we are all addicted for similar reasons. A substance of choice is the only difference.

  5. Bob K says:

    I find the rabid “singleness of purpose” folks to be a bit like the Japenese soldiers that were found in jungles long after WW II had ended. The war was over, but they didn’t know it. There’s enough in the world that’s aggravating without manufacturing misery regarding a ship that has sailed.

    Great essay. We need more of this type of thing.

  6. PJ says:

    To add a balance to the comments I would like to add my two bobs’ worth.

    First of all, I would like to say that I have no medical or scientific qualification in the area of Alcoholism or Addiction. My experience is purely as a layman and sober alcoholic member of Alcoholics Anonymous in Sydney. My sobriety began when I identified with the drinking stories that I heard in meetings of Alcoholics Anonymous in a similar vein to Dr Bob when Bill W told him his story. I wasn’t there at the time but I assume their respective stories as written in the book Alcoholics Anonymous are reasonably true.

    Identification as an alcoholic in AA meetings, whether theistic or secular continues to support my sobriety. We have had many of the unfortunate instances already mentioned of arguments over whether addicts/alcoholics are the same or should be allowed to participate in the same meetings whether they be AA, NA, GA or many of the other numerous fellowships. Certainly, the discussions can be somewhat robust at times and I don’t want to enter into the same argument here. All I can say is that I don’t identify with addiction but I do identify when I hear alcoholic drinking stories and subsequent attainment of sobriety (hopefully) in AA. Some addicts that I have met in AA have emphatically told me that all addiction is the same. I disagree but no longer get into discussion or argument about this, I am simply an alcoholic on my say so, no one else’s.

    I am fortunate to live in a city with over three hundred AA meetings per week to choose from. This allows me to find meetings where I feel comfortable and can identify with other alcoholics. I have found that alcoholics of a similar mind to mine gravitate towards the same AA meetings and they provide a comfortable and safe space for me to occupy.

    At the risk of becoming too scientific on the subject of alcoholism, I will mention one book that I found to be a valuable read for the unqualified such as myself. I also want to thank John Lauritsen for mentioning it in one of his books. The book is called ‘Under the Influence: A Guide to the Myths and Realities of Alcoholism’ by Dr James R Milam and Katherine Ketcham.

    Thank you for the article and I appreciate the opportunity to add a comment and I wish all who read this a happy and fulfilling life.


  7. Dan H. says:

    Great piece. I came in in 1987, right when the treatment-center floodgates opened and scared the pants off “real alcoholics.”

    I like to point out to the singleness-of-purpose quibblers that our book begins with this passage from The Doctor’s Opinion: “A well-known doctor, chief physician at a nationally prominent hospital specializing in alcoholic and drug addiction…” I think this is a natural and useful conflation. It has occurred to me that what traditional AAs are afraid of is not so much the differentiation in substances as it is of drug culture, which (at the risk of using too broad a brush) has its own style, lingo, and legal complications.

    As to the idea that behaviors can be looked at as addictions (gambling, eating, sex, etc.), that’s fine but I’m pretty sure I don’t want to share a meeting with a non-drinker suffering from an eating disorder; I can have sympathy, and even understanding, but as a former alcohol-cocaine-Valium abuser I need identification with other users of intoxicants. Meanwhile, I put my behavioral problems in the unmanageability bucket.

  8. Sonny L. says:

    This essay is totally correct. I’ve been an addict my whole life. Before my life became unmanageable I was a “functional drinker and user” for 50 years. I never got a DUI or used at work so I didn’t believe I had a substance abuse problem. I falsely believed that I controlled all my use. It took an addiction to Tramadol ( a mild “opiate”) and the worst depression of my life in withdrawal to force me into rehab. I accepted the first step and I realized I’d been lying to myself for years. Just because I could quit cigarettes doesn’t mean I can control all addictive substances. Today I practice the 12 steps and attend meetings everyday. I understand that drinking one lite beer or taking one inappropriate pill is quitting sobriety and relapsing. I can enjoy life without getting high so my need for any substance abuse is nil.

  9. Bryan T. says:

    Every person in this world is an addict. It’s fine to be addicted to things. It is the ABUSE of anything that I think many refer to as addiction. We are all addicted to water, air and food. Without these we die. We need them and we crave them when we don’t get them. The today term “Hangry” ring any bells? I am an abuser of alcohol, but not cannabis. I had major surgery in August and even though I said no narcotics – they still used them and I was addicted to opium/morphine by the time I got out of the hospital. I went through another withdrawal. 10 days to stop feeling pulled toward something and sweating and irritable. But I can gamble, eat chocolate and ice cream. I feel there has been too much segregation of addictions. It’s the same problem over and over again.

    If you have read this far, perhaps you can share your thoughts on this. I feel that most of the people I know who have addiction problems are also “all or nothing” personalities??

    • Mark B says:

      There is an important difference between the terms “addicted” and “dependent.” I had gangrene set in my leg because of addiction to alcohol. Complications from the amputations have left me dependent on morphine for chronic pain. Without morphine I would have NO quality of life. NONE. I wouldn’t be able to attend meetings. But you know what? Across the top of my chart at the pain clinic it reads, “Substance Abuse History Use Extreme Caution.” And they KNOW because I told them. They count my pills and urine-test me constantly. That’s the accountability the program gives me. If I drank alcohol or took something mixed with Tylenol I would be dead in DAYS, not weeks. My sponsor knows this, my home groups know this, and my doctors know this. And I still work the steps…. I am dependent responsibly, not addicted and out of control!

  10. Pat N. says:

    Good summary. I’m heartened to see how many of us are now indifferent to separating folks on arbitrary standards. I don’t care if someone broke their leg falling off a barstool or on Mt. Rainier – they’re in pain, they want help, and I need to pass it on.

    For several years, I’ve introduced myself in meetings as “I’m Pat, and I used to be addicted to alcohol.”

    #1 I’m asserting that as an ex-drunk, I’m brother to junkies, methheads, pill poppers, whatever. We all vomited in the same toilets.

    #2 If I haven’t had a drink in a few decades, how can I say I AM addicted? I certainly have the potential to get hooked again. That’s like saying I’m addicted to mother’s milk, since I relied on it for months.

  11. Mark P. says:

    I do not differentiate between alcoholism and addiction, anyone who problematically indulges in a behaviour, (English spelling, I’m from the UK and refuse to accept American hegemony of the English language!) despite the seriously negative consequences and cannot stop is an addict. However, I understand why people in AA meetings object to people sharing about heroin or whatever, this can put off newcomers who will be looking for excuses not to identify i.e. looking for differences. I don’t care if people share about other addictions in AA meetings though.

  12. Richard K. says:

    I loved this article so much. I used to identify myself that way. My sponsor said to me that he used to do the same. He then told me that he was an Alcoholic who picked up a slight drug Habit along the way.

    I have to remember when AA originated. It was in the 30’s. But I agree an addiction to anything is to me the same. I like the saying, “Changing seats on the Titanic.”

    HAH!!! I am having a real problem with Tic Tac’s lately. I will have 6 packs on me at all times. My disease is centered in my Brain. I came for my drinking and stayed for my thinking. Learn a way of living. A Sober life.

    Not always easy.

  13. Chris G says:

    A few years ago, I was at an AA meeting, and a newcomer (new to that meeting) identified as an addict. It was a closed meeting. Some members took that to mean closed to everyone except alcoholics. The situation escalated very nearly to a fist fight. The addict finally left, tail between legs. Several members left too, to go catch up with him, apologise, and take their own meeting to McDonalds. A couple of them never came back. The group, it was my home group, was never quite the same after that.

    I was only about a year and a half sober; this was all new to me, and very disturbing. I just sat there in a stew, embarrassed and confused. I felt both the draw of the “only us alcoholics” group-think, and the utter disaster of turning that fellow away.

    After a lot of thought and talking with my sponsor and other friends, I too decided that addiction was addiction, and help was where you can find it. After a few months I left that group. I have heard since that it has disbanded, after nearly 50 years in existence.

    How much that incident contributed to the group’s final failure, I don’t know. But looking back, I realise it was an in-grown group, totally dominated by a few old fossils, big-book thumpers, and just unable to attract younger people. The canon of ye olde AA is a bigger problem than just that of “the god thing”.

    • John L. says:

      At core, alcoholism is a physical addiction to ethyl alcohol, although of course there are psychological issues involved. There has always been a need for closed meetings — meetings open only to alcoholics. Only alcoholics can fully understand and relate to each other.

  14. Ray M says:

    To the Agnostic in recovery the addictive substance should be as insubstantial as all the various sects of religions are. None better, none worse. All roads lead to Rome.

  15. Mark B. says:

    I was told a little joke by my very first NA sponsor. “Do you know the difference between an alcoholic and an addict?” he asked. I replied that, no, I didn’t. “An alcoholic will steal your money and run. An addict will steal your money – and then help you look for it.” For some reason I found that joke very funny. I think it was because I knew deep down that I was the “help-you-look-for-it” type, and that, therefore, I was in the right fellowship – NA. It’s weird, though. (When I tell that joke to NA people they laugh uproariously. AA people? Not so much. They mostly look puzzled).

    I mostly go to AA now, but I have a home group in both. The reason? Because, to me, 12 steps is 12 steps is 12 steps. I have felt just as comfortable in GA, OA, AL-Anon, CA, and more. I now work as a Peer Support Specialist at a hospital and I tell my patients that making distinctions like that almost killed me. I have seen it almost kill others, too, especially newcomers when they come to an AA meeting and identify as an addict and some old-timer leans over to someone else and hoarse-whispers, “I think he may be in the wrong PLACE!” I liken that to something near manslaughter if that person goes back out and dies of an overdose after feeling excluded and humiliated. C’mon! Enough with the exclusivity and the labeling! We’re all in this together. (Don’t get me wrong–scholarly articles examining the distinctions are important and educational).

    None of us have to be “professionals” to help someone else. Service to others is key. And in the xA anonymous fellowships, our 12th step binds us to encourage someone to get help SOMEWHERE, whether it’s Rational Recovery, Smart Recovery, Refuge Recovery, AA, NA, CA, Hip Sobriety, whatever – climb in with a program and hang on for the ride. The opposite of addiction is community!

  16. Jeanine B says:

    Thank you for this article. When I first entered recovery in 1986, several of the AA meetings I attended had a disclaimer at the beginning stating that “if you have a problem other than alcohol, please seek out the 12 Step program specific to your addiction” (or something to that effect). Many meetings still speak to “singleness of purpose” and that speakers “confine your remarks to alcohol.” I get it – the whole can-the-newcomer-relate piece, “and” a drug is a drug is a drug. Actually, I’d prefer to confine my remarks to recovery, from whatever the particulars of the disorder.

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