Alcohol use disorder (AUD) is characterized as a pattern of problematic drinking that causes significant health issues and distress in an individual’s life. Despite the many physical, mental, and social problems associated with chronic alcohol intake, the individual continues to drink. Those around the individual may attempt to make sense of the problem. One major and relatively obvious way people make sense of a problem is through language — but more specifically, words and speech. In my experience talking about problematic drinking and AUD, I have frequently heard people boldly and assertively ask, referring to someone they know, “How can we fix them?” That terse, but very complex question, frames the need for treatment in a way that puts the spotlight on the individual.
“Fixing” means that a particular aspect of someone is malfunctioning and needs to be brought to a state of normalcy. Yet, what is normal? Normality is defined by a society and certain institutions and groups within that society, such as experts, lawmakers, and educators. In the case of AUD, normal is what lies outside the parameters and specifics of the DSM-V, a diagnostic guideline created by the American Psychiatric Association (APA) for clinicians.
Unfortunately, it is not that easy to “fix” a person suffering from AUD and return their physical and psychological processes back to a “normal” state of functioning. The road to normalcy is an obstacle course of barbed wire, trenches, and explosives, all obstructing the path to victory. Language in the form of “how can we fix them?” is Janus-faced. It is contradictory in that it seems to fault the individual at a time when they are vulnerable. It is symbolic of the barbed wire, the trenches, and the explosives.
The language we use toward those with problematic drinking can affect their behaviors and become a self-fulfilling prophecy (the idea that our beliefs about ourselves or others can become true through our expectations). Thus, if person A holds and communicates the belief that person B is unintelligent, then person B may begin to think of themselves as unintelligent.
Our own feelings about others are reinforced by their beliefs and actions. In a cyclical fashion, our own feelings about others impact and influence others’ behaviors. Equivalently, when someone is told they need to be fixed, they may think there is something physically or mentally wrong with them that makes them incapable of controlling the alcohol intake. Thus, actions, thoughts, and words about problematic drinkers may work in a contradictory way in that those with a drinking problem may really believe and think that they are alcoholics. In that sense, they may continue to reinforce those expectations by continuing to consume more alcohol.
Imagine someone who has a heart attack and undergoes surgery. Their heart may be fixed; however, the doctor not only has to focus on the actual heart but on a host of other variables, such as the victim’s age, family history, beliefs, and lifestyle (e.g. physical activity, drug use). The doctor must also look at situational and cultural factors that led to the heart attack and how to mitigate their effects post-surgery.
That is also the case when someone suffers from AUD. The language we use should decentralize them as the source of the problem by recognizing that AUD involves different angles and aspects of the being. Therefore, the language should refer to and incorporate the mental, physical, spiritual, and social dimensions. People who suffer from AUD have differing and often complex histories and life narratives. There could be many traumas, coupled with physiological and genetic factors and risks. There could be certain norms and patterns of socialization within a particular culture that could influence the propensity for certain individuals to engage in problematic drinking.
With AUD, the being is not separate from their sociocultural context, but instead needs to heal within those sociocultural contexts and histories. I am suggesting that when we talk about helping people with AUD, we use language which is empowering. Instead of “fixing” someone, perhaps we could really emphasize terms like healing, treatment, and support — terms with a positive connotation. These terms relay the message that those who suffer from AUD need to rebuild as a whole being. They show that other people care. In conjunction with proper medical care, more positive language tells people affected by AUD that they should have the necessary social supports and a chance to recover from their sociohistorical situations. “Fixing them” language admits that an us vs. them dichotomy exists, with them being a marginalized, retreatist subculture. Emphasizing terms with a positive connotation sends the message that the community, including the victim, play a role in the recovery process.
Shaffer, H.J. (1986). Conceptual Crises and the Addictions: A Philosophy of Science Perspective.
Journal of Substance Abuse Treatment, 3, 285-296. Retrieved from https://www.researchgate.net/profile/Howard_Shaffer/publication/19861590_Conceptual_crises_and_the_addictions_A_philosophy_of_science_perspective/links/55fb8f6908aeafc8ac41bacd.pdf
University of Maryland Medical Center. (2015). Alcohol use disorder. Retrieved from