Alcoholism and diagnostic creep (starring Kirstin Davis)

Kirstin Davis has been annoying me this morning.  The doctors’ on call room here is full of celebrity magazines; they’re always a few weeks old and these ones have a lot about the new Sex and the City movie.  Here are some of the headlines:

Now Magazine 26 May 2008

Kristin: ‘I’m a recovering alcoholic’

Q: You admitted to suffering from alcoholism in your twenties.  Is there any truth in the rumours that you relapsed and went back to rehab?
A: I haven’t had a drink for 20 years now.  I haven’t kept it a secret but people don’t really know about it*

{nb the other four headlines were Cynthia: ‘I’ll wed my lesbian lover’, SJP: ‘I’ll miss Carrie’ and Kim ‘My tomboy keeps me young’}

Reveal Magazine 24 – 30 May 2008

‘I’m not ashamed to be an alcoholic’

‘Her co-stars may be toasting the release of the new Sex and the city movie with champagne, but Kristin Davis won’t be joining them
The star, who plays Charlotte in the New York-based sitcom, hasn’t drunk alcohol in more than 20 years because she had a drink problem.
She says ‘I’m an alcoholic, but I haven’t kept it a secret.  I’ve been sober for a really long time now’

She certainly doesn’t look like an alcoholic to me.  Davis is 43, and since you can legally drink at 21 in the USA this didn’t provide her with much of a window of opportunity to get really stuck in.  Neither article gives us much in the way of details as to what Davis got up to whilst she was a boozing.

Some more digging revealed this interview from the Guardian in 2002:

‘To the outside world, I was a good girl. But I drank a lot, which was rebellious because my parents didn’t drink at all. In the South, pretty much everybody drinks. There was always lots of alcohol, lots of access to alcohol, people sitting around every night with a Mint Julep, or whatever.’ …. At high school, it was just crazy. We’d all be behind the gym drinking, about 20 people passing around bourbon or whatever.’

Throughout our conversation, Davis has been sipping water, but she refuses my offer of wine: ‘No, I’ve been sober a long time.’ Did she end up having problems with alcohol? ‘Oh yes.’ I didn’t know that. ‘Not many people do. There’s this whole thing in America about talking about all your addictions and problems and I’m not really into that**. But it’s not like I want to keep it a secret either.’ What happened? ‘Oh, nothing that bad. I just realised that drinking was counterproductive to what I was trying to do. Acting is very difficult in weird ways. You’d have to get to class by 8am, work all day, rehearse all night, and it’s not really good to do when you’re hung over. I’d wanted to be an actress my whole life, that was my goal, that was all I cared about. Something had to go, so I chose drinking to go.’ Has it been difficult? ‘Oh yeah. Sometimes it would be nice to just have some red wine with dinner, but it’s not worth the risk. I have a great life, a great situation. Why would I want to risk self-destructive behaviour? Even though I might not, I might , do you know what I’m saying? You just never know.’

So, in summary Davis drank a lot whilst she was a rebellious student but then she realized that hangovers weren’t compatible with having a career and making something of yourself.  So she stopped.  Um, I did that too (without actually stopping mind).  Does that mean that I’m an alcoholic too?  ’Alcoholic’ is a poorly defined term, and this is where the confusion may lie.  But if by alcoholic Davis means ‘alcohol dependent’ she’s stretching it rather thin.  If a psychiatrist were to do this, this would be an example of criterion or diagnostic creep, where a previously well defined syndrome widens to include experiences that were previously thought to be a part of normal experience.  Has Davis actually seen a doctor, or is she a self-appointed recovering alcoholic?  PTSD is often accused of criterion creep and this can occur easily for psychiatric syndromes, where the aetiology is unknown.

Why has Davis appropriated the language of psychiatry and addiction to explain her own reaction to what many people would consider a normal stage of many people’s lives?  Perhaps as a way to draw attention to herself, to explain other failings in her life about which we know nothing, or so that she may permanently have one foot in Parsonssick role.  My esteemed colleague, on call with me today, ‘Dr Cynic’ is proposing that Davis is so boring that her alcoholic ploy is a way to spice herself up in the eyes of her public.

For what it’s worth, ICD-10 requires that three of the following criteria be experienced or exhibited at some time during the last year for a diagnosis of dependence:

A strong desire or sense of compulsion to take the substance

Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use

Physiological withdrawal state when substance use has ceased or been reduced, as evidenced by either of the following: the characteristic withdrawal syndrome for the substance or use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms

Evidence of tolerance, such that increased doses of psychoactive substance are required to achieve effects originally produced by lower doses

Progressive neglect of alternative pleasures or interests because of psychoactive substance use and increased amount of time necessary to obtain or take the substance or to recover from its effects.

Persisting with substance use despite clear evidence of overly harmful consequences (physical or mental)

For an interesting account of the effect of alcohol and other drugs on society try the following two books by Griffith Edwards:

Matters of Substance – Why Everyone’s a User

Alcohol: the World’s favourite drug

*It’s certainly out of the bag now – I don’t think that talking to NOW magazine is a very effective way of keeping a low profile on this one.

** So what are you doing talking about it here then?

8 Responses to “Alcoholism and diagnostic creep (starring Kirstin Davis)”

  1. Dr Cynic says:

    In summary, this woman is talking utter bollocks. Not once does she mention a physical or psychological dependence on alcohol; she has, in fact, merely declared that she detests hangovers in the most inappropriate manner, getting herself some pretty sensationalist headlines to promote her rubbish film.

    This nonsense has got to stop!

    P.S. FP – do some frigging work!

  2. Dr Cynic says:

    I am now considering becoming an “alcoholic” if it means looking that good at 43…

  3. Frontier Psychiatrist says:

    Dr Cynic – do some frigging work!

  4. Dr Cynic says:

    What do you think I’ve been doing all weekend, FP? Blogging?!

  5. NorthernIrelandExile says:

    For someone who likes to keep the subject quiet, it’s amazing that she has been giving interviews on the matter to the national press since 2002.

    By her definition I’m an alcoholic too :>

    I hate hangovers when I have to work the next day, but worse is the paranoia that stems from maybe smelling of alcohol. The good news in my line of work is that both my clients and judges have a propensity to have a boozy lunch, which thankfully reduces their ability to detect that I was out the night before!!

  6. TheShrink says:

    So, so agree. It’s very frustrating when “I was depressed” or “I was an alcoholic” is cited as a medical diagnosis and specific state when in fact it’s meant/should be stated as a personal or social comment.

    I whittered on about exactly the same thing last month, since even in formal mental health services we don’t see true ICD-10 alcohol problems every day.

  7. Narconon vista bay based program is designed to help their graduates not to be fallen again to any addiction. They will stay confidence, under control, and able to achieve their goals without any expose of drugs.

  8. who would have thought beautiful & sumptuous actress Kirstin Davis of sex & the city was a alcoholic!this tells us alcoholism is a disease just like every other one & we shouldn’t be ashamed of it. this needed to be treated well before its too late.

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