Bear in mind that bad behavior does not make for bad people. When we get to the addictive character versus addiction as a behavior, this will become a bit clearer.

Here is a video by Dr Sadaqat on alcoholism in Pakistan
Dr. Sadaqat Ali talks about Alcoholism in Pakistan

The romanticized version of the addict as the skinny, slovenly, unshaven guy with the rheumy eyes in the flannel shirt is not really accurate. I helped a friend of mine kick a 5 bag a day heroin habit cold turkey a few years ago (now, that was an experience) and he wasn't exactly some junky living in a box. In fact, he is a high school music teacher, dresses in Armani, plays in a major city symphony and, at 53, still takes his elderly Mom to church three days a week.


A genuine, dyed-in-the-wool alcoholic drinks consistently, day and night. They are typically malnourished, and, basically, live on booze. They are never quite drunk and never quite sober. Clinically, this type of drinking is called maintenance drinking, as it supplies a biological requirement that the body develops for a certain level of alcohol in order to function. Many of you likely encounter a maintenance level alcoholic or addict every day, and don't even know it.

Along with the chronic alcoholic and/or maintenance drinker, we have what I call the cyclical alcoholic. This is the addict who engages their behavior in a consistent timeframe, like not drinking during the day, but coming home at night – every night — and drinking a few bottles of wine, or a twelve pack.

There is also the binge drinker, who may drink socially or not at all during the week, but spends every weekend trashed. Or again, characterized as a binge drinker, goes through periods of relative or even complete sobriety, then falls into a period of chronic or cyclical alcoholism that can last a few days, a few weeks or a few months.

Some binge drinkers also tends to be what are known clinically as blackout drunks. A blackout drinker gets to a point where they are literally unconscious on their feet. They may appear sober or only slightly "buzzed", but they are not cognizant of anything that is happening around them, what they are doing or how they are acting.

I must admit to not completely understanding the biological mechanism that drives this, but it is more common than you might suspect. Bear in mind that blackouts are often associated with a particular type of alcohol and, in rare cases, it can be an allergy. I knew a woman in college who would blackout after one or two beers. Regardless, it's a dangerous condition, as the personality and behavioral changes associated with blackout drinking can lead to some very risky behavior.

There are also reactive drinkers, conditional drinkers and coping drinkers. A reactive drinker is someone who will seek out alcohol in response to a particular emotional state – say, stress or loneliness. This is the guy who keeps a bottle in his desk at work or the housewife who carries a hipflask in her purse. A conditional drinker will engage in their behavior in something of a ritualistic fashion – eating dinner alone, or watching a game on TV, but nowhere else. A coping drinker is someone who hasn't developed an alternative coping skill and uses their addiction as that, and only that. All of this falls under the category of self-medication, by the way.



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