20/20...Alcoholism

Great Debates
1

Anybody see 20/20 last night? The expose on alcoholism and alternative treatments. I fell asleep on the end of it, I wanted to watch it all. I’ve been interested in this for years. Had heard of “Harm Reduction” and several other approaches that are European. Anyone have any thoughts on this? Wondering how many 12 Steppers we might have out there that are so well invested in the disease model that they’ll think I’m Satan for even bringing this up. But is alcoholism a disease? I know it’s been a very good excuse for a couple of the alcoholics I’ve known, but for some reason I just kept seeing it as a behavior pattern or a choice. Any thoughts?

Need2know

2

I see it as a series of choices that can lead to addiction.

Not a disease.

-VM

3

If it is a disease then alcoholics should sue under the American’s with Disabilities Act. They shouldn’t be arrested for drunk driving, public drunkeness, or any crimes committed while under the influence. A disease is something you have no control over.

Actually alcoholism is a character flaw not a disease. I'm sure various medical folks here would disagree with me.

Marc

4

You think that’s crazy I’ve even seen a theory that so called Co-dependents have a character disorder!

Need2know

5

Disease? Character Flaw? Moral Shortcoming? Genetic Disorder?
Medico types have been in disagreement on this for some time, and to some degree it depends on how you define “disease”. It has many of the characteristics of a disease (progressive nature, typical course, typical outcome, strong familial tendency), but the at least seemingly voluntary nature of the “early stage”, if you will, is contrary to traditional disease concepts. I suspect it is like many things in life - a complex combination of factors, some genetic, some “learned”.

Slightly, perhaps way, OT
Probably need input from those directly in the trenches, but from my tangential involvement…
From a practical standpoint, it’s just semantics. My experience is that people who get highly charged over a particular “tag”, in either direction, have some personal motivation. I pass no judgements, mind you, on either/any camp. I imagine for some alcoholics, the disease concept makes sense to them and gets them past guilt/shame, and allows them to lead a contented, productive life without the use of alcohol. I imagine for some non-alcoholics, this seems like a cop-out. But does it really matter?
If I’m a quart-a-day vodka drinker, spewing havoc upon myself and everyone I come in contact with, and I come to realize “I have a disease”, get help, and stop drinking, am I…unworthy…copping out…full of shit…because I choose to call it a disease?
By the same token, If I’m a quart-a-day vodka drinker who says “Yes, I agree, that disease stuff is crap, I have a serious moral failing” and I continue drinking my face off…is that somehow…better? Does the “it’s a moral failing” camp prefer the “admittedly morally flawed” drinker to the “hiding behind a disease” sober person?
I use these examples merely to illustrate this point: bottom line, it doesn’t matter how anyone classifies it, if you’re an alcoholic, it behooves you to do something about it, regardless of any whys, hows, or whats.
As far as “12 steppers”, I cannot speak for them nor would I, but it is my understanding that the organizational philosophy has never been that theirs is the only way to stop drinking, nor that it is for all alcoholics, but that this is merely what has worked for them, and that anyone who feels that they have a drinking problem is free to give it a try, no strings attached. There have been other options in this country for some time (psychotherapy/counseling, religion, Rational Recovery, Members in Moderation) (may have those last two wrong), and 12 Step programs don’t vie with them or each other for “market share”, nor disparage the efforts of other approaches. They merely say “hope it works for you; if it doesn’t, you know where to find us if you want”. This is not to say that individuals don’t sometimes say/act otherwise, but that is an issue of the individual and not the organizational philosophy.

Shaky Jake
first time in GD - be gentle, I left my helmet at home

6

I really don’t think that those proposals would fall under the ctegory of “reasonable accomodation”.

So lung cancer, ulcers, AIDS, and depression are not diseases?

I think that we need to make a distinction between alchoholism and drunkeness. The former is a disease; the latter is a choice.

7

So just because it is the result of lifestyle choices, it isn’t a disease? I guess that rules out heart disease, lung cancer, colon cancer, just about every other cancer, STD’s, AIDS, just about any infectious disease (hey, you chose to leave the house), etc., etc.

We like to think of alcoholism as a disease because 1.) it implies that the alcoholic is not a bad person, but a person with a problem to be overcome, 2.) it is a physical condition, in that alcohol causes physiologic dependence (that is, there are withdrawal symptoms), and 3.) it implies that it can be treated.

There is a general feeling that psychiatry (my likely profession) defines various “diseases” to absolve the patient of responsibility for his actions–alcoholism, ADHD, social anxiety disorder, etc. This is not the case at all. Conditions like these are defined and given names so they can be discussed and treated.

It really does come down to your definition of a “disease”, but as psychiatry comes out of its dark ages I expect the line between “disease” and “character flaw” to be blurred considerably. In my experience, though, those who object to calling alcoholism a disease are just trying to assert their moral superiority.

Dr. J

8

I think the problem with the “disease” model is that it does tend to remove responsibility from the person for their actions. No, not every alcoholic claiming alcoholism is a disease uses it as an excuse to drink. Likewise, not every family member, doctor, or friend of an alcoholis uses it as a rationalization for the other’s behavior. But, a lot of people do use the disease model in this exact way, and that’s why there are objections to it.

DoctorJ has far more medical knowledge than I do, and I’m sure that there are criteria that must be met for things to qualify medically as a disease. But the common everyday definition does assume that it is something you have no control over. A predisposition to addiction to alcohol may be a disease, but being a drunk is not. One is a condition, and another is behavior. In my experience the folks who object to the definition of alcoholism as a disease object to the definition of the condition being used as a rationalization for the behavior.

9

I dashed this OP off rather hurriedly. As for the disease module, if you’d like to call my question acting out some kind of moral superiority then do so. Fine with me. You are absolutely right, my opinions about this subject are a little biased. Unless you’ve been abandoned by an alcoholic father, beaten by an alcoholic husband, and had your checking account wiped out by an alcoholic boyfriend, unless alcoholism has touched your life in some way then I’d say regardless of your medical training you don’t really know squat. Unless you’ve spent years looking for medications, detox programs, preachers, programs or whatever trying to help the alcoholic in your life then maybe you don’t know enough about the “disease” yet.

Things like Rational Recovery was mentioned, that’s basically a 12 step program just without the “higher power” thing that is so central to AA’s program. And yes, AA is very vocal about it’s protestations that you either abstain or you die. As far as I have seen there are no programs that help problem drinkers deal with moderation, I’ve looked for them. Maybe out on the West Coast but I could find few even on the internet. The only “moderation” programs I could find were in Europe. From what I have seen for so many of the alcoholics I’ve met and known it was this idea that they could never be normal, never drink like a normal person that was their biggest hurdle. AA and many other programs also rely heavily on the “hitting bottom” theory. Why should anyone wait until they are puking every morning and shitting blood on a daily basis. Many alcoholics do. But they resist these programs because they require such a drastic change in lifestyle.

I have often felt that this was an area of study that needed a closer look. If anyone listened to the statistics given at the beginning of the program then it certainly does make sense. The most heavily abused drug for adolescents is alcohol, it is present in 70% of all child abuse cases, 75% of all domestic violence cases, 40% of all traffic accidents, and so on and on. (Please do not screw with me about these statistics. I don’t care if they are off a little. If they are out and out lies then I’m sure someone will notify 20/20. If you think so then write them yourself. Don’t remind me not to believe everything I hear.)

I have just never understood why this problem appears to be so well pushed under the rug in our society. The effects of alcoholism in our society solidly outweigh the effects of other kinds of drug abuse yet the treatment of this problem has not been addressed for decades. Even AA admits that their program has an 80 to 95% drop out rate. Wow! I’d say that for most people that program is a big failure. So what kind of answers are being looked for in the medical community? Doesn’t look like many. If you go to AA or ALANON they will tell you that for every alcoholic the lives of at least 4 other people are affected. That’s a lot of people. Perhaps it’s time to try something different.

Anybody else got any thoughts?

Need2know

10

I agree that the issue is how you define “disease” Is alcoholism a psychological disorder which results in significant distress and impairment? Certainly. Does alcoholism result from personality disorders and personal life choices? Also certainly. There is actually very little empirical debate on either of the above points.

The disease model endorsed by the 12-step programs suggest that there is a direct link between a set of genes and a compulsion to engage in drinking behaviour. The implication is that the individual has no control over his/her behaviour and is essentially “forced” to engage in alcoholic behaviour, and thus is not at “fault” for his/her behaviour.

This strick 12-step model has largely been disproven empirically (see the work of Linda Sobell, who’s research on Controlled Drinking therapy was groundbreaking on this issue).

However this does not mean there aren’t any disease-like facets to alcoholism. A person could have some genes which put them at risk for depression, which coupled with environmental stress could lead them to choose to engage in drinking to self-medicate. Are they essentially at fault for this behaviour? Absolutely. Much the same as are people who smoke and get lung cancer, eat fatty food and get heart disease, etc.

The reason many people in psychology and medicine are reluctant to think of alcoholism as a disease, is because this implies that the individual does not play a role in brining on the disease, but with alcoholism this is a false conclusion.

But as some mentioned, it all depends on how you define disease.

11

Needs to Know:

I think we both posted about the same time, so let me respond to one or two points.

There actually is a very famous controlled-drinking study by L. Sobell. IT has been repeatedly demonstrated to be as effective as AA (which as you mentioned is not tremendously effective).

The question also is…is it the alcohol which makes people (your father, boyfriend etc.) act in antisocial ways…or is it that antisocial (and borderline) personalities gravitate toward the consumption of alcohol. Empirical evidence seems to suggest the latter. Obviously your personal experiences suck, and in general I can not comment on what you went through. But generally people who steal while alcoholic are simply acting out their baser instincts. The alcohol doesn’t make them mean/criminal, etc. They have criminal aspects to their personalities…consuming alcohol may just help them get over what few moral reservations they have left.

12

Yes Avalon…I know what comorbidity is. Yes, I also know a few little statistics that I memorized in my studies on this subject…i.e. In Bipolar disorder comorbidity of drug and/or alcohol abuse exsists on a 9.2% ratio. And yes alcoholism and drug abuse do also go hand in hand with typical anti-social behavior. I know what it’s like to self medicate I’ve had a drink myself on Friday after an especially stressful week.

But then I also have a friend right now that is an alcohoic and is not a sociopath. She has held a job for 20 years, is raising a child, and would give you the shirt off of her back. I have a friend that is a recovering (you never say cured) cocaine addict he’s never stolen a dime in his life. Yet both of them are without a drivers license and have had to spend time in jail due to their addictions. (Oh yeah and my husband never hit me unless he was drunk. I’m sure he wanted to when he wasn’t just lost that little inhibition when he was.)

What galls me is that our society still does not think this problem needs to be addressed. I’d be willing to bet that every one of us knows or knows of a problem drinker be it a family member, friend or co-worker yet we are still reluctant to address the issue. It doesn’t matter if you are married to some truck driver that gets tanked every Friday and beats you silly or if you’re married to a corporate exec that sits and drinks martinis until he passes out every night. This problem is as serious as breast cancer, aids, or any of our other health or social problems.

Need2know

13

The Ryan sensibly replied to MGibson:

Exactly. And does anyone imagine that people who are, say, legally blind as a result of macular degenerative disease wouldn’t be arrested for attempting to drive, simply because they can’t help their blindness?! Come off it: just because we call something a disease doesn’t mean that we absolve the sufferers from all responsibility in dealing with the consequences of the disease.

Kimstu

14

I need to put my disclaimer about anecdotal evidence not repudiating empirical research in my signature line.

As I mentioned, not all alcoholics have antisocial PD…but could be responding to depression, etc. Also a number of individuals with Borderline PD (for which the comorbidity rates with alcoholism are exceedingly high) engage in substance abuse…they are not “bad” people, just chronically distressed people who contribute to their own problems…much the way alcoholics do!

If we acknowledge that alcoholism starts with individual choices…this does not mean we don’t want to cure/treat it. Would you suggest L Sobell had no interest in helping people simply because she questioned the disease model?

Incidently the “rule” about saying alcoholism/SA is never “cured” is a 12-step rule. Much like any disease, once you pass a certain high-risk recidivism date, you can pretty much call yourself cured. Now if you still have borderline personality problems, focus on them, but alcohol ain’t causing them.

After all, do middle aged individuals who had cancer when they were children still consider themselves to be diseased?

15

So now I’m lost Avalon…what’s your point? There may be a couple of studies out there but there are no programs. At least not any that the average person has access to except AA. Any thoughts on that?

Need2know

16

Needs2know wrote:

Perhaps because so many people view it as a “behavior pattern or choice”? You asked “So what kind of answers are being looked for in the medical community?” Why should the medical community look into a “treatment” for a “choice”, or a character defect, or a moral failing, or a lack of intestinal fortitude? Being a bit facetious, divorce is also a huge problem in this country, causing significant problems for many innocent children. It is also a choice or behavior pattern. What answers are being looked for in the medical community for this problem? Why would anyone look for answers to a choice?
I am truly sorry for all the heartache that alcoholism has caused you; I have felt my share as well. But you started the OP seeming to say “this isn’t a disease, that’s just an excuse used by people to justify their lifestyles”, and then wondered why more wasn’t being done about this huge problem. Unfortunately, there is likely no medical treatment for “being a jerk”, “being weak” “poor character” “being morally defective”, or the myriad of other negative tags that get placed on alcoholics. Furthermore, with negative tags like that awaiting from the rest of society, and internalized to at least some extent by the alcoholic, is it any surprise that so many have to get so bad before they are willing to admit to having a problem?

Shaky Jake

17

NeedstoKnow:

No particular point, just sharing information.

Controlled Drinking is one national alternative to AA if you want a non-disease model approach.

Then there is…oh, gee where would one go if one had psyche problems causing distress/maladjustment…therapy?

don’t mean that as sarcastic as it sounds, but given the low rate of AA success (which if I remember, you noted) why not actually try to work on the root of the problem…which often is mental illness/personality disorder.

What else don’t you understand, perhaps I am not being clear?

18

Hmm… What exactly would you propose be done? When you say that nothing is being done I have to think of just how many hundreds of AA chapters and other organizations there are strewn across the nation. As a (clearly hasty and admittedly unrepresentative) sample, I grabbed the phone book. (Springfield, IL pop. approx 100,000 in case you are wondering.) Under “alcoholism” there are 16 local agencies plus a toll free number to the Betty Ford Center. Clearly there are a lot of people interested in doing something about it, but it just doesn’t seem to be as successful as we would like.

Whereas AIDS, cancer, and other illnesses are physical ailments, alcoholism is basically a behavioral disorder. That alone makes it much more difficult to define let alone treat. AA has a list of questions that if you answer “yes” to any of, they consider you at risk to be an alcoholic. Just about anyone who has had a wild night or two will answer a couple of them affirmatively. And as far as treatment goes, other than some few mood altering drugs (DoctorJ will no doubt have better info for us) I think it’s all basically talk therapy. I’m not too sure that such therapy will ever be more than modestly effective, whether alcohol is completely off-limits or used in moderation.

19

Two points:

  1. My personal experience with alcoholics is a father-in-law and two brothers-in-law who are lifetime members of AA, for the last 25 years. They had to hit bottom before they would go, but go they did, and it worked for them.

  2. Americans tend to have a very peculiar attitude towards alcohol, a lot of emotional baggage left over from the Puritans and the Calvinists and the Victorian era and ESPECIALLY the whole Temperance movement and the Prohibition era. Americans don’t seem to know how to drink to moderation, the way the French do with wine or the Germans do with beer. Sometimes it seems like they only understand either complete abstinence, or complete, binge drinking (I’m talking about as an entire culture, not on an individual basis.) In the movies, you never see an American family sitting down to dinner with a bottle of vin du pays or bottles of beer on the table, unless it’s an “art” film. American families at dinner in the movies drink Pepsi, or milk, or juice.

Anyway, all this means is that the problem of alcoholism is something that nobody really wants to talk about, because they don’t know how. To a significant percentage of the population, alcohol has a negative connotation of “sin”, people go on “binges”, they drink “booze”, there are any number of negative synonyms for liquor, but never anything positive.

So AA’s approach is rooted in this “all or nothing” religious background, and it does work for a few people. Some people with little self-control do better if they have an outside authority laying down the law to them, someone they have to be accountable to.

P.S. People have been brewing alcohol and getting drunk for thousands of years, but it’s only in modern post-industrial culture that suddenly “alcoholism” is a problem. Why is that, anyway?

20

Also to add onto that last point…evolution typicallytakes tens if not hundreds of thousands of years to make majour genetic changes…since alcohol has only really been consumed for a few thousand years, I have always wondered…what did the alcoholics do before alcohol? :slight_smile: