I can't say someone's a drunk, or someone has "a drink problem." That could be a perjorative and unjust opinion. As a medic, pronouncing such a formulation or diagnosis has consequences (with driving, insurance, all sorts). As such, as with all good diagnosis, a combination of clinical acumen and a diagnostic framework guides formulation. The bottom line : I have to go by what our diagnostic bible, ICD-10, says.
This means that instead of "alcoholic" I end up with the less than catchy diagnosis of "F10.241 Mental and behavioural disorders due to use of alcohol, dependence syndrome, currently using the substance (active dependence), with physical features".
Or I can opt for "F10.1 Mental and behavioural disorders due to use of alcohol, harmful use." At least that's shorter to write.
Thus, it's not common for me to make such a diagnosis partly 'cause such folk go to drug and alcohol services and partly because the diagnostic framework means I've quite a high threshold before someone can attract such a diagnosis.
I was helping a gentleman who's almost 90. He was up before 7.00am today and went shopping at 8.00am. Does all the cooking, cleaning, washes all the crockery, pays all the bills, sorts all the post, does the laundry, vacuums and tidies up, does everything. He's knackered. At almost 90, although in decent physical health, he's unable to manage the volume and intensity of activity he's undertaking. It's not tenable over the long term.
He's not my patient, he's never been referred to me. It's his son, who's almost 70. His GP didn't think he was depressed but very sensible sought an opinion since it's all so grim, so he came to my corner. His son sits in bed most of the day, drinks vast amounts of alcohol and is dependent on his frail elderly father for everything. Not because he's physically unwell, or disabled, or has deficits. But because the son likes it this way, it means he can kick back and drink. Stress free, eschewing all life's responsibilities.
I really feel for his proud father, who's struggling but can't and won't thrust responsibility back to his son or accept social care/anyone doing things for them.
I can't cure this.