A non-comprehensive collection
My Good Friend, the DSM-IV
May 9, 2018Posted by on
I knew that tone. An octave lower and considerably softer. It’s the preferred medium for the abrupt, serious segue. Appropriate for anything from “Your fly’s open” to “The cheerleader’s dead.” It was the summer of 2009 when my then-girlfriend’s mother employed it to accuse me of having a drinking problem. “We need to talk about it,” she said, easing into her ambush. Next time, I thought, I won’t offer to help make corn salsa.
I stopped chopping cilantro. Emphatic and without pause, I affirmed, rather convincingly, how my incessant binge drinking had been done with the utmost responsibility. For being caught off guard it was the most courteous way to convey how they were mistaken and that I was, indeed, flawless.
It seemed they hadn’t expected resistance. Frankly, though, I hadn’t expected them to forego social etiquette and freely address a houseguest’s unfounded health issue in front of God and the free world.
There was no need to raise my voice or address their egregious shortcomings. Just because this family was willing to ignore decorum didn’t mean I needed to stoop. Manners, I remembered, never take a vacation.
I conceded her mother’s credentials immediately, her Master’s in Social Work and her twenty years of field experience. Working ahead was critical, as I’d try to take the sting out of any justifications that might later be thrown in my face. Four semesters into my Psychology B.A., I could attest that alcoholics in the “wild” were typically sad, saggy people. I, quite conversely, was a pleasant, taut specimen who merely indulged in an eccentric hobby. I lived adjacent to a college campus, not a gutterslum. When—and if—I ever started failing classes or picking fights at the car show then I’d consider entertaining their claims. “Truly,” I said. “This is a non-issue.” I assured her that, no matter what anecdotes her daughter had relayed about my ruining various mattresses or various birthday parties, I had total control over my four-to-five weekly nights of binge drinking.
Her mom’s cadence and volume increased as she rattled through a list of productive alternatives to drinking. It felt exceedingly rehearsed. I nodded, politely and the way you would if you were actually considering what was being proposed.
“You say ‘tomato.’ I say ‘tomato’ differently,” I offered. Taken aback, they were trying to discern if I was operating on a higher plane or had just thrown out a non sequitur. Silent, and too embarrassed to clarify, they exchanged glances. “The diagnosis you’re proposing requires objectivity,” I said, quite rationally in the face of their histrionics.
We, of course, could sit here all day, speculating and subjectively debating on what type of alcoholic I’d devolve into. They sided more on the “degenerate” and “disgusting” iterations where I gravitated towards a higher likelihood of an adult who is ”high-functioning” and “adorable”.
I didn’t chide their shamefulness, despite their charge being untethered to any professionally derived standard. Objectivity was vital, yet both sets of eyes narrowed when I suggested The Diagnostic Statisticians’ Manual—truly the American Psychological Associations’ gold standard. They were both wary but had no move to refute my gambit.
I fetched the household DSM-IV and rifled through to find “Alcohol Abuse and Alcohol Dependence.” I was genuinely giddy. A few months back in class we’d discussed substance abuse and examined this exact criteria. As one does in every psychology class, I had conducted a self-audit and—just like every other normal, reasonable person—I’d then played out in my head potential arguments about this topic and how I could refute and undermine every potential claim levied against me. I don’t mean to boast; I’m just that healthy and well-adjusted.
“Ahem,” I quieted the room as I laid the tome on the kitchen island. “The DSM-IV distinguishes between ‘Alcohol Abuse’ and ‘Alcohol Dependence.’ One is not necessarily conditional for the other.” I wasn’t actively trying to talk down to them, but I didn’t have another way to lecture. “’Alcohol Abuse’ is defined as any one of the following:
1-Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
“In the splendid years I’ve spent with alcohol, I’ve been nothing but a paradigm of punctuality.” They didn’t say anything, though I could sense their eye rolls were cued. “Alcohol, if anything, has helped me draw boundaries between leisure and responsibilities.” My girlfriend protested, asserting that my neglected apartment was disgusting. “Of course it’s gross and full of garbage and laundry. I live with three other twenty-year-old men. We’re apathetic man-children and that’ll assuredly continue, drunk or sober.” She moved to refute, but I ended her erroneous line of post-hoc reasoning. “The fireworks warehouse I work at, furthermore, has been delighted by my competency and literacy, which are not common qualities among their work force.” I smirked. “And college classes have been a breeze—did I mention that I’m a psychology major?”
2-More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex?)
“I don’t drive or use machinery when I drink. Though the DSM-IV doesn’t specifically define ‘machinery’. I’m assuming they mean things more in the wheelhouse of ‘steam shovel’ or ‘cotton gin’ rather than a cell phone or a toilet.” My adversaries conceded that, as they are no strangers to using phones or indoor plumbing when they are mildly intoxicated. “The college campus I bumble through drunk is the same one I march through sober.” She nodded reluctantly towards her mom. “I haven’t been swimming in quite awhile, nor have I engaged in any sex that would be any more unsafe than it would have be when we are lucid.” I paused and waited for a prompt, though unsurprisingly neither asked for greater detail. “I think we all use forms of technology and machines when drinking. Is that thoughtlessly irresponsible and grounds for an entire point here? I’m genuinely asking.” Her mom said that she didn’t think that she, herself, abused alcohol. “Okay,” I said, “let’s give us all a half point on that one.”
3-More than once gotten arrested been held at a police station, or had other legal problems because of your drinking?
“Easy. I’ve never had any legal problems, related or unrelated to alcohol. Looks like I have a buffer, too, since this clarifies as ‘more than once.’” My girlfriend bit her bottom lip. “Take out a Freedom of Information Request if you don’t believe me.” I touted myself further as nothing more than a wonderful and respectful drunk in my underage tenure.
4-Continued to drink even though it was causing trouble with your friends or family?
“You two seem to be the only ones who think I have a problem.” Her mom claimed this would satisfy the criteria. “If you two were simply more accepting of me the way I am, my habits wouldn’t be considered alcohol abuse.” I could hear the collective sigh. “This criteria doesn’t account for false positives. In fact, I could make this exact claim against each of you.”
“That’s different, Justin; we both know that her and I don’t abuse alcohol.”
“I know I don’t abuse alcohol either.” We were either all persons who abused alcohol or none of us were, and they weren’t willing to make that concession. “Through four, it seems we are each at a half point and, therefore, not individuals who abuse alcohol.
The color had gradually left their faces. It was the unmistakable look of someone who had brought piss to a shit fight. Those four had been a nice warm-up, a preview of coming attractions and airtight logic. I moved onto to the main event, “Alcohol Dependence—a less-sad way to say ‘alcoholism’—is defined as any three of the following seven.”
1-Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
“This is on me. I don’t keep a diary or spreadsheet of drinks ingested.” The scowls began fomenting. “I usually lose count after four, and that’s always been the case.” Her mom clarified that constituted binge drinking. “I was never claiming that I didn’t binge drink,” I said. “Let’s all try to stay on topic.”
2-Found that when the effects of alcohol were wearing off, you had withdrawal symptom, such as trouble sleeping, shakiness, restlessness, nausea, sweating, or a racing heart? Or sensed things that were not there?
“Never experienced any of these. I simply drink until I pass out and then wake up about eight hours later, fresh as a spring daisy.” I paused, “Nausea has occurred on several mattresses, birthday cakes, and parking lots below balconies, though never as the effects were wearing off.”
3-Had times when you ended up drinking longer than intended?
“Okay. Fine. Yes, I do often drink for longer than intended, but it’s only because we’re having so much fun. I’ll admit to this condition.” My girlfriend, unsatisfied, said she had been terrified when I’d gone on that bender one Thursday last month and didn’t call or stop home for three nights. “Yes. I vaguely remember that,” I said. “Pretty sure I already said I’d surrender this point.” Christ, they were really clinging to anything they could.
4-More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
“No. I’ve never once tried to stop, but thank you, DSM, for another built-in buffer.” Collectively they emitted the loudest scoff I’ve ever heard. “I don’t intend to try to stop. And I don’t plan on these good times ever ending.”
5-Spent a lot of time drinking? Or being sick or getting over other after effects?
They thought they had me on this, but I knew an over-generalization when I saw one. “You admitted,” her mom said, “that you drink four to five nights each week.” She cocked her head to the side. “I’d call that a lot.”
“I’m never sick the next day. Plus it’s a college campus, and relative to the social norms established there, I’m par for the course. I sleep every night each week, but wouldn’t consider it to be ‘a lot’, as it’s consistent with the averages of those around me.”
“My friends don’t drink like that,” my girlfriend said. “Maybe two or three nights a week. At the most.” I asserted that I knew people who drank every night, and some who drank every night and every day.
“’A lot’ implies a relativity to the surrounding around it. Bad example, but an arson charges and two Alaskan cruises in a year would seem like ‘a lot’ for one person. Although, you might think differently if your spouse was a career cruise director who dabbled in arson.” Deconstructing language could always catch people off guard. They thought this was going to be a by-the-number affair, those poor knaves. “People are drinking constantly around me, as I still do live by a college campus. I could concede a half point—at the most—on this.”
“Fine, “ My girlfriend said as she had so many times before in that terse, loaded voice.
6-Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
“Mom, remember when you were visiting and I invited him to come with us to the arboretum?” A smug look wormed its way onto their faces.
“To be honest,” I said, “I knew I wouldn’t find the arboretum important or interesting, and I knew it would not give me any pleasure to visit with you two.” They stood, stunned at this apparent revelation about observing trees. “The fact that we were drinking instead is besides the point when I didn’t want to go in the first place.” Even though her mom wasn’t at all related to me I could sense an “I’m disappointed in you” right around the corner. “I’m twenty and in college. Drinking is my preferred form of recreating. I assure you, there’s no great novel or triathlon I’ve been putting off.”
7-Continued to drink even though it was making you feel depressed, or anxious, or adding to another health problem? Or after having a memory blackout?
“No need to put on airs, DSM-IV, we just call them ‘blackouts.’” Their eyes weighed on me. “Yes. Agreed. I’ll take the point for this one. “
The list was over. I’d scored a generous two-and-a-half out of seven, a firm half point below the threshold for determining a person with “Alcohol Dependence.” I didn’t need to gloat. Their dejection said it all.
Take that, girlfriend’s concerned family.
We went back to making corn salsa. Finding we were much better able to discuss baseball or the weather.
*In 2013 the DSM-V came out with anew criteria for alcoholism. Though more stringent, it can still be refuted by those willing to argue.
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