I. Introduction and Alcoholism Defined Some have suggested that alcoholism is a disease, but the debate as to whether alcoholism is actually a disease or a problem in one’s choice of personal conduct has a long history. Is alcoholism actually a disease? Many of the factors and issues behind this debate appear to be based on speculation, emotion, politics and money.
After smoking, alcoholism is the second largest cause of drug related of death in the UK with about 7. 7 percent of British adults dependent on a drink. About one quarter of all accidents at work, 15 percent of road accidents, 26 percent of all drownings and 36 percent of all deaths in fire are alcohol related. This leads to about 33,000 alcohol related health problems, incidents and deaths per year in the UK.
This topic is the focus of continuing emotional debate and probably has no resolution. Certainly, we cannot label alcoholism as a disease unless with have a definition of a disease. Once we have defined “disease”, we need to determine what alcoholism is and then determine if this concept fits into the definition of a disease. As you will see, ultimately, this approach merely leads back to the question it was designed to answer.
Random House Webster’s Unabridged Dictionary, 2nd Edition, defines disease as a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment while Dorland’s Illustrated Medical Dictionary defines it as any deviation from or interruption of the normal structure or function of a part, organ, or system of the body as manifested by characteristic symptoms and signs; the etiology, pathology, and prognosis may be known or unknown.
Dorland’s defines alcoholism as a disorder characterized by a pathological pattern of alcohol use that causes a serious impairment in social or occupational functioning. In DSM-IV it is covered by alcohol abuse and alcohol dependence and Random House Webster’s defines it as a chronic disorder characterized by dependence on alcohol, repeated excessive use of alcoholic beverages, the development of withdrawal symptoms on reducing or ceasing intake, morbidity that may include cirrhosis of the liver, and decreased ability to function socially and vocationally.
Does alcoholism fit the criteria to be referred to as a disease by the definitions presented in Dorland’s and Webster’s? After having considered those definitions, the issue remains unresolved. In its definition of alcoholism, Dorland’s refers to DSM-IV. The criteria for diagnosing alcoholism in DSM-IV refer to social and/or legal problems and do not include any physically measurable symptoms but only requires alcohol withdrawal as the one physical symptom of “alcoholism” even though withdrawal is an outcome of excessive drinking and, as such does not support the idea that excess drinking is a disease, but rather that it leads to disease.
Tobacco use from smoking is similar to alcohol in that nicotine results in withdrawal symptoms when a smoker stops smoking and smoking causes numerous actual diseases, yet DSM-IV does not label excess smoking as a disease, which is a contradiction that only leads to further confusion. People commonly use the words, “Alcoholism is a disease” without explaining to what they are referring. Certainly, nobody can argue that alcohol dependence is not a medical/health condition, but is that what the term “alcoholism” refers to?
Does “alcoholism” refer to the drinking behaviour, the subsequent medical problems and diseases that arise from drinking, some specific disease state or some combination of these and other factors; to what exactly does the sentence refer? We can only determine what they are referring to by inference, so by inference, it appears that “alcoholism” refers to the behaviour of drinking in excess, chronic drinking. After having reviewed the dictionary definitions of “alcoholism” and “disease,” let us define the apparent definition of “alcoholism” being referred to by the statement, “Alcoholism is a disease.
” Alcoholism is “excessive drinking”. This is the definition of alcoholism we will be referring to throughout the rest of this essay. By using the mathematical concept of substitution, we can now transform this statement, “Alcoholism is a disease” into the statement, “Excessive drinking is a disease. ” In order for a medical situation to be classified as a disease, it should have characteristic symptoms that can be measured and observed, but in the case of the “disease” of alcoholism, the symptoms can only be observed after drinking.
The AMA defines alcoholism as, “An illness characterized by preoccupation with alcohol and loss of control over its consumption, such as to lead usually to intoxication if drinking; by chronicity, by progression and by a tendency toward relapse. It is typically associated with physical disability and impaired emotional, occupational and/or social adjustments as a direct consequence of persistent excessive use. ” This long definition can be reduced to, “Excessive drinking.
” Although the American Medical Association (AMA) claims that alcoholism is a disease, the organization that most commonly and loudly proclaims that alcoholism is a disease is Alcoholics Anonymous (AA). AA claims to deal with and treat this disease, but AA is not a medical organization, so whatever “treatment” AA provides consists of some form of non medical approach that deals with the behaviour associated with drinking rather than any medical condition that drinking might cause.
Therefore, by inference, we can conclude that the term “alcoholism” and the sentence “alcoholism is a disease” refer to the behaviour of drinking in excess—chronic drinking—rather than any medical condition that might be associated with the habit. If alcoholism is a “disease” and alcoholics are people with the disease of alcoholism, how and why does AA, a non-medical organization, serve as the main source of “treatment” for the “disease,” a medical condition? It is illegal to practice medicine without a license, so how does AA get away with it?
As you can see, from the very beginning of this assessment, it is apparent that the statement, “Excessive drinking is a disease” is absolutely ridiculous or, at the very least, a contradictory concept. Groups with XA (X Anonymous) where X can be any behaviour (gambling, drinking, sex, smoking, etc. ) taken to excess are common and plentiful. Obviously, AA does not treat a disease. That would be illegal. It is a programme of behaviour modification to stop people from drinking rather than to treat a medical condition. As a programme of behaviour modification, it is a failure.
It relegates people to a self-fulfilling prophecy of failure by assuring them that they will always be “recovering alcoholics”, never recovered “former alcoholics”, a negative placebo effect. We will return to this point later. If we look at this from the point of a habit, we can see that any conquered habit leaves open the possibility, usually a very good possibility, that the individual will resume the habit if they repeat it even once, but certainly, the more they repeat it, the more likely they are to resume it.
So, it is not a disease that they are referring to, but a habit. In most diseases that are brought about by habits (and most diseases are caused by habits), if you repeat the practice just once, you will not end up with the disease again although, in some situations, you may temporarily get sick, but if you return to the habit, you are likely to end up with the disease again. So, the AA warning that alcoholics are always “recovering” and never recovered has the sound of dealing with a habit rather than a disease.
Once again, this is a psychological condition (non medical) rather than a psychiatric condition (medical). This point is clearly driven home when it is noted that the “health” care professionals most generally associated with AA and AA style treatments are counselors generally with absolutely no training in medicine but often with at least some training is psychology—no sign of a disease here! II. History of the Concept and The Controversy Although the disease concept was introduced by Dr.
Benjamin Rush in the 19th century, medical professionals initially debated the idea that alcoholism is a disease beginning early in the 20th century. The idea that alcoholism is a disease was made popular by E. Morton Jellinek, M. D whose 1960 book The Disease Concept of Alcoholism, and report (Jellinek, 1952) outlined the stages of alcoholism. His book was withdrawn by him (at the request of Yale University) in 1960, the year his book was published, because its ideas did not stand up to scientific scrutiny.
Yet, the AMA, medical professionals and American and British culture have bought into the disease model for alcoholism and “embraced (it) and quickly applied it to every possible deviant behaviour from alcohol abuse to compulsive lecturing” (Falcone, 2003) even though the inception of the current disease and treatment paradigm was based on faulty science and fraud. In 1956, the American Medical Association labeled alcoholism as an illness and in 1966 the AMA recognized it as a disease.
Historically, this decision was wrapped in controversy and was essentially a political rather than a medical decision in nature. III. Treatment for “the Disease of Alcoholism” The most common and universal approach to treat the “disease” of alcoholism is the “Twelve Step” recovery programme used by AA. Summarized, these 12 steps are: 1) to admit being powerless over alcohol, 2) to believe in and seek help from a Higher Power, 3) to make a decision to change, 4) to make self-evaluation/inventory, 5) to admit to God our wrongs (confession?), 6) to have God remove character defects (cleanse one of sins? ).
7) and shortcomings, 8) make amends to those harmed (repentence? ) 9) except where it would injure others, 10) continuous personal inventory and admission of wrongs when recognized, 11) prayer and meditation and 12) continued practice and carrying the message to others (proselytizing? ). As you can see, this 12 step programme is a religious programme essentially based on Christian principles in the belief in God, turning your affairs to God, admitting sin and powerless over sin and then repenting and proselytizing.
It is a “religious” rather than a medical treatment and it is designed to deal with habits, not diseases. Which one or more of these 12 steps is designed to treat a medical condition? Each and every one of these 12 steps to “recovery” are adapted from Alcoholics Anonymous and mimicked by the various splinter groups that have sprung up from AA through the years such as Gamblers Anonymous (GA), Sex Addicts Anonymous, Sexaholics Anonymous (SA), Narcotics Anonymous (NA), Overeaters Anonymous (OA) and Nicotine Anonymous (NA).
Since each of these programmes, and others like them, follow the same 12 step AA programme to treat “a disease”, we could assume that each of these programmes treats a disease—the same cure for all of the diseases. Nowhere in medicine do five to ten totally different “diseases” have the same not one, but twelve methods of treatment, and medicine does not label the excessive practice of any of these habits as being a “disease” except for excessive drinking; “excessive drinking is a disease”.
All of the steps are Christian based religious (not spiritual, which is not the same as religious, i.e. , spiritual – having to do with the spirit, vs. religious, i. e. , having to do with one or more religions, an important point since alcoholism probably has to do with matters of the spirit; a person’s behaviour is an abstract, spiritual thing even if the person is not religious at all) principles that focus on altering habits. None of these principles focus on dealing with a medical condition even though some of the organizations that use the principles (AA, both NA groups, and even OA, for example) deal with habits that can and often do lead to serious health concerns.
Although AA has adopted the “disease” model for excess alcohol use, the other organizations do not claim that they serve as treatment for “a disease” nor for any of the real diseases brought about by the associated (and causative) behaviours. For example, smoking is associated with at least twenty different diseases including atherosclerosis, hypertension, vascular disease, stroke, various forms of cancer, impotence and other diseases.
Nicotine and alcohol lead to similar types of health concerns such as addiction and withdrawal symptoms, and yet smoking is viewed as a habit rather than a disease. If NA is designed to deal with a habit that leads to disease rather than dealing with a disease, and the NA programme and the AA programme provide the same “treatment”, then either both are “treating” habits or both are treating “diseases”. Which is it? While some of the chemical and psychological addictions with which these programmes deal have physical consequences, others do not.
For example, gambling is purely a psychological addiction and while both overeating and sex have physical/physiological and psychological effects, with only a few exceptions, neither overeating nor overindulging in sex generally indicate the existence of a disease. (The addiction to sex is generally more of a psychological addiction but the habit and sexual reactions cause physiological changes. ) Even though gambling is basically a psychological addiction, both gambling and sex may result in the stimulation of pleasure centers in the brain and give rise to the release of endorphins in the brain.
Endorphins are protein compounds produced by the pituitary gland and hypothalamus that mimic the action of opium in producing feelings of pleasure. The Royal College of Physicians published a report in February 2000 which concluded that cigarettes and nicotine are as addictive as heroin and cocaine and that nicotine is the cause of addiction. This finding concurs with a 1988 report by the U. S. Surgeon General reaching the same conclusion. (Stolerman & Jarvis, 1995) This is quite different from stating that smoking in excess is a disease.
Rather, it leads to the conclusion that smoking is a habit that leads to the diseases associated with smoking by virtue of the nicotine in tobacco. Smoking to excess is not a disease! It is the cause of disease. Therefore, the 12 step programme designed to help smokers quit IS NOT a treatment for a disease, but a method to deal with behaviour that leads to disease. Still, a related question does arise with respect to smoking: To what extent is the habit of smoking controlled by physiological addiction?
The first aspect of this question must be that the physiological addiction cannot control smoking initially because the addiction doesn’t initially exist! However, once the addiction arises, then it might contribute to the continuation of the behaviour meaning that the addiction might feed on the behaviour and the behaviour feeds on the addiction. Despite the belief that an addiction can be recognized when encountered, there is no universally accepted definition for addiction.
The World Health Organization defines addiction as A state, psychic and sometimes also physical, resulting in the interaction between a living organism and a drug, characterised by behavioural and other responses that always included a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absences. Tolerance may or may not be present. (World Health Organization, 1992) Ironically, the AA-like organizations that “treat” alcoholism and similar behaviours do not treat any of the actual diseases associated with excess drinking.
Actually, they can’t do that because they are not allowed to do so. That would be practising medicine without a license. Certainly, once the habit of drinking to excess becomes ingrained in an individual, stopping the habit becomes more than just a matter of willpower, but while the AMA does not want alcoholism to be judged as a problem of willpower, initially, drinking to excess, alcoholism (which is excessive drinking rather than the diseases that result from excessive drinking), is a problem of willpower and those involved with excessive drinking will not be able to deal with that situation until they face that reality!
In fact, the very first point of the AA 12 step programme is for the alcoholic to admit that to being powerless over alcohol and the second step is to resort to help from a Higher Power. Of course, this is a defeatist attitude and places a negative placebo effect, and perhaps results in the negative hypnotic suggestion on the drinker that, “I can’t overcome my excess drinking problem. ” However, the AA programme clearly acknowledges that dealing with alcohol involves some aspect of willpower!
The AMA estimates that 25-40 percent of all hospital patients are there for ailments related to “alcoholism” (excessive drinking? ), that is not the same as saying that alcoholism is a disease. Many individuals are in hospitals as a result of tobacco smoke, but a significant number of these are the victims of passive smoking. AA statistics support the fact that the AA approach to dealing with alcoholics does not work. In fact, studies have conclusively shown that untreated alcoholics are about 2 times more likely to get sober and stay sober than alcoholics treated by the twelve-step AA approach.
(Falcone, 2004) Whether or not the medical community and/or AA care to admit it, except drinking is a behaviour and researchers in sociology and psychology have long realized that behaviour problems cannot be inappropriately turned into medical situations even when they can cause medical problems. You cannot label a person who becomes despondent and attempts suicide because of the sudden death of a loved one as a person with a disease. They are what they are, despondent, and have merely reacted to their sudden situation.
Their reaction is not the result of a gene leading to a genetic effect, a protein imbalance nor to any other related medical situation outside of their sudden change of psychological/mental state. Over the past few decades, geneticists have begun to refer to “genes” that cause “the disease of alcoholism”, but that interpretation appears to be a misinterpretation of the data that oversteps the boundaries of the studies. III. Research Literature
Recently, a great deal of research has developed and been pursued regarding the existence of genes that may cause alcoholism. While the data from such studies may be accurate and compelling, the interpretation of that data is in question. In general, the typical interpretation leads one to conclude that the existence of a gene or a set of genes may predispose individuals to drink. By following this pattern of interpretation, are we to assume that an individual who drinks when he or she is frightened or worried has a genetic predisposition to do so?
Even if his or her parents did so, and they share a gene in common, the actual truth is more likely to be that the drinking behaviour arose from learning in the environment—the child grew up seeing that his mother, father or both dealt with worry, concern or other problems in life by turning to alcohol. The existence of the common gene had little or nothing to do with anything. A British researcher, Dr. Brian Goodwin, notes “that a predisposition can only prove a difference in bodily processes, not a difference in thinking.
‘Knowing the sequence of individual genes doesn’t tell you anything about the complexities of what life is. ‘” (Baldwin Research Institute, 2005) Goodwin goes on to note that “single gene mutations are not accountable for, and cannot explain, complex behaviours. Genes produce proteins rather than guide behaviours. If there is a genetic predisposition for substance abuse, it has no bearing on subsequent behaviours. Individuals make a conscious choice to drink that is not determined or influenced by genes, bodily processes or the chemical processes… The amount consumed is determined by the individual not by the body.
“Today, lots of research is being interpreted as suggesting that there is a gene for alcoholism, and many researchers are jumping onto the bandwagon, but the interpretation of those studies is questionable and generally not supported by the available statistics. For example, the Baldwin Institute reference (above) also refers to a study by Blum and Noble that reported a significant difference between the frequency of the A1 allele at DRD2. However, other geneticists who summarized the results of the Blum and Noble studies reported the same frequency for the A1 allele at DRD2 (. 18) in alcoholics, controls and severe alcoholics.
(Gelernter, Goldman & Risch, 1993) IV. AA and General Treatment Success Although some diseases cannot be cured, many can. Although AA claims a success rate for “treating the disease” of alcoholism, there is no need to point out the statistics because AA despite its claims of success, AA claims that alcoholism cannot be cured. Therefore, the what is the answer to the question, “What is that success rate? ” The initial answer is “Zero”. Whether or true or not, this answer leads to a self-fulfilling prophecy that certainly must lower the success rate of the AA approach if there are any successes.
Previously (above), we have noted that AA drives the point home to its members that they will “always be recovering alcoholics” and will never recover. This claim is based on the belief (which is accurate and true) that if a former drinker should take even a single drink after never having had a drink for 50 years, they could instantly return to drinking (alcoholism). This claim, although true, is also ridiculous if applied to disease situations and can even be an exaggeration when applied to habits, but it drives the point home that the AA approach deals with a habit rather than a disease.
Although returning to a habit that has caused a disease in the past, such as cancer, may sometimes cause medical and physical discomfort if the habit is resumed even once, in general, the habit will not cause the disease unless it (i. e. , the habit) is repeated a number of times. For example, let us consider a habit similar to drinking—smoking, which causes many different diseases such as lung cancer—and consider what happens if a person who hasn’t smoked for a decade suddenly picks up a cigarette and smokes.
It is true that this person may end up returning to the habit of smoking, but that one cigarette will not lead to a return of lung cancer. Resuming the habit might. This fact emphasizes the fact that AA deals with a habit rather than a disease. The AA programme for treating alcoholism advises those being “treated” that they need to live “one day at a time” and that they should not fool themselves into believing that they can be cured. Therefore, by its own admission, the AA treatment success rate is “zero”. If no one can be cured, then nobody has been cured!
Yet, AA points to statistics claiming success, obviously a form of doublespeak. Yet, the actual statistics on success using the AA programme come closer to their claim that “the disease of alcoholism cannot be cured” than their opposing and contradictory claims of success. The empirical evidence demonstrates that organizations that adhere to the disease concept fail to help individuals with substance abuse problems. (Brown, 1991; Kolenda, 2003). By contrast, programmes that teach choice rather than the disease concept have success rates as high as 86 percent after five to ten years.
(Baldwin Research Institute, 2003) V. Psychological and Cultural Factors All substance abuse is a behaviour! Any behaviour has and leads to consequences. Alcoholism is a behaviour. If a person repeatedly crosses a busy intersection without looking at the light, he or she will end up being hit by a car. Are we to label their refusal to adhere to the traffic signal as a disease just because it ultimately results in predictable medical outcomes including broken arms, broken legs, fractures, concussion and even death? The obvious answer is “No!
” Crossing against the light is a behaviour, not a disease, and while it is possible to have a disease that causes this behaviour, the behaviour itself is not the disease and most people with the behaviour are not afflicted with any disease. The accepted criteria for labeling an individual as an abuser of alcohol come from the DSM-IV. It does not provide symptoms and focuses on behaviour. To be certain, a behaviour can be indicative of a health problem, but most behaviours are merely behaviours and ALL BEHAVIOURS have consequences.
The major requirement for diagnosing alcohol abuse is withdrawal symptoms. The research evidence suggests that drinking behavior is a matter of personal choice (rather than a disease) in which the individual, family and friends may all interact to assist the drinker in dealing with and overcoming the undesired drinking habit. (Velleman, 2006) This choice is influenced by many factors, including psychological, familial, cultural and other environmental factors. (Dotinga et al. , 2006; Hammersley et al. , 2002). VI. Summary and Conclusion.
In this essay, we have defined alcoholism as excessive drinking and used the mathematical practice of substitution to transform the statement, “Alcoholism is a disease” into the statement, “Excessive drinking is a disease. ” This transformation suggests that the idea is ridiculous. Obviously, excessive drinking is a habit of choice rather than a disease, and habits are not diseases. The universally recognized “treatment” for alcoholism is the 12-step “treatment” programme used by AA, but splinter groups have arisen for treating other troublesom habits, and all use the 12 step treatment programme of AA.
This 12 step “Treatment” programme appears to be a method of dealing with undesirable habits (of which alcoholism is merely one) rather than treating disease. The 12 step “Treatment” programme appears to be based on Christian religious concepts and beliefs, especially the concepts of guilt, sin, confession, cleansing one of sins, repentance and preaching the word to others. The concept that alcoholism is a disease, originally championed by E. M. Jellinek is the subject of much debate but has little solid research to support it. Alcoholism appears to be a habit that leads to disease.
Many social, psychological and cultural factors give rise to the habit. Although there are methods to deal with and treat the habit successfully, promoting the idea that alcoholism is a disease does not appear to be a successful means of dealing with the habit. ?
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