What Should an Alcohol Problem Look Like On-Screen?

Take a moment to picture someone who has a problem with alcohol. A “drinking problem.” 

Got it?

If your notion of “drinking problems” is informed mostly by film, chances are the person you just pictured meets a couple of common stereotypes. Their drinking is visibly raucous (the life of the party!), or visibly lonely (alone in their basement). Or maybe their life is quite palpably falling apart: their family is worried, their friends are watchful, their employer is ticked off.

If, on the other hand, your awareness goes deeper than that – if you have personal familiarity with “drinking problems”– perhaps you pictured someone you know. Maybe you pictured the distinctly affected way that your sister gazed at you, gazed blearily at the world, after a couple of drinks. Maybe you remembered how your best friend in college would sink into a corner, sink into some unknowable reality, bottle in hand. Or maybe you grabbed a snapshot of yourself – the first time that you didn’t study quite hard enough for a test because you were hungover. That time when you hurt a friend’s feelings while drunk. The time you opted out of doing something important, something meaningful, something way more you – because hitting the bars sounded like more fun. 

Maybe you remember asking yourself: Does she have a problem? Do I have a problem? before quickly dismissing it.

After all, your drinking – her drinking – most drinking – doesn’t look like “problem drinking” in the movies. For that reason, we don’t often confront it. As storytellers, it’s up to us to change the narrative, to change what people picture when they picture an alcohol problem.  

Alcohol use disorder: an invisible problem

It may seem counterintuitive to refer to alcohol use disorder, or AUD, as “invisible.” After all, alcohol is a key player in thousands of car crashes, deaths, and sexual assaults annually. The CDC estimates that the cost of excessive alcohol use is 249 billion dollars every year. Far from being “invisible,” alcohol use disorder seems like one of the most obvious problems we have. (Although, in 2021, it’s facing stiff competition.)

In part, that’s true: many signs of alcohol use disorder are obvious. The Diagnostic & Statistical Manual – 5, as well as two of the most commonly used screeners for AUD - the CAGE and the AUDIT - include visible, clear-cut indicators of problem drinking. Things like: People criticizing drinking. People expressing concern. Drinking first thing in the morning. Injuring oneself or others while drinking. Failing to fulfill major obligations. These are visible signs that someone has a “drinking problem.”

And yet, these screening tools include just as many symptoms of alcohol use disorder that are totally invisible. For example, there’s the feeling you need to cut down. There’s the desire to cut down, followed by unsuccessful attempts. Sometimes those attempts are unsuccessful due to strong desires, urges, or cravings. (And it’s not always “the shakes”; sometimes, these cravings are purely psychological.) There’s telling yourself, “I won’t,” followed by “maybe I will.” There’s saying “Maybe just one,” followed by maybe just three. And there’s guilt about drinking – So. Much. Guilt.

For some, there’s the feeling of being less oneself while drunk: the feeling that a small part of oneself has been lost to the subtle erasure afforded by alcohol. Sometimes, this erasure of self is welcome: a little less perfectionistic. A little less attached to expectations. Sometimes, it’s less welcome, as the activities that we used to prioritize are quietly displaced by alcohol.  

Here’s my point: The empirical criteria at the heart of alcohol use disorder are, quite often, invisible. On-screen, the pre-game or the frat party might be likely habitat for AUD, but this disorder can just as easily inhabit a quiet night of board games, a dinner date with mom or dad, or a weekend with a good book. If you’re a storyteller, this raises important questions: How do we tell a truer story about alcohol use disorder? How do we make the invisible visible?

Actionable insights: Making the invisible visible  

Here are empirically supported ways to tell a truer story, and to help your audience spot the signs of alcohol use disorder in themselves. 

• Obsessing: After a character drinks – regardless of whether the drinking was uneventful or disastrous – they are soon eager to drink again. They are already thinking about the next opportunity to drink. This is especially key in young characters, who may not have constant access to alcohol. It’s not always about drinking regularly; sometimes, it’s about thinking about drinking regularly.

• Wondering: In thinking about her alcohol use, a character asks herself, Is this normal? Could my drinking be a problem? Perhaps she floats this idea by others. It isn’t often that people without a drinking problem repeatedly wonder if they do, in fact, have a problem. 

• Disappearing: When a character drinks, his countenance and behavior is significantly different from when he is sober. He seems to be seeking a break from simply being himself. He craves permission to be someone different. Something fundamental to the character has vanished, and he is happy to see it go.

• Erasure: Think about the long-term consequences of disappearing, of shooing away these fundamental pieces of oneself. Over time, it culminates into a less colorful, less varied, and less individualized life. In the context of a character’s timeline, the introduction of alcohol might correspond with a gradual diminishing of self. 

Getting personal

Remember that friend who sinks into the corner? The sister whose hazy eyes betray that, inside, a fundamental piece of herself has drifted away? 

That was me.

Within six months of my first drink, I suspected that I had a problem. Four years later, I got help. In between, I told myself that I couldn’t possibly have a problem. I just couldn’t. Drinking problems are easy to spot, I thought, reflecting on the portrayals of problem use I’d seen in books and on screen. That’s not me.  

That’s what the media had taught me: drinking problems are obvious. They are sometimes wild. They are, at the least, a little messy. And so, I thought, the college student voluntarily reading her fifth empirical article that evening, getting up intermittently to refill her glass, could not possibly have a problem. 

But I could. I did. And if I’d ever seen a relatable portrayal of alcohol use disorder on-screen, maybe I would have done something about it sooner. Maybe the cognitive dissonance would have caught up to me a little quicker. It’s time to give your audience that chance. Teach them something different about alcohol use disorder.

Anna Joliff, she/her/hers, MS Counseling Psychology

Research Specialist for the Social Media and Adolescent Health Research Team (SMAHRT)