Yes, I know they’re classed as such. Here’s why I’m asking.
Topic of discussion at the monthly get-together with friends wandered around to the concept of alcoholism and its treatment. One of my friends said that she thought it was classed as a disease simply because they wanted insurance to pay for it.
Her reasoning: a disease is something that happens to you - you catch the flu, for example. There are things you can do to minimize the risk (flu shots, washing your hands, etc.) but you really can’t prevent it. Alcoholism and drug abuse are absolutely, 100% preventable. You just say no.
And that was her point - since alcoholism is completely brought on by the deliberate action of a person, it shouldn’t be classed as a disease. Doing so allows the addict to completely sidestep responsibility for their actions and blame it on the “disease”. And that kinda made sense after I thought about it for a while.
So I thought I’d pitch it out here as a topic of discussion. What do you think?
I think a lot of alcohol abusers are labeled as alcohol addicts. There’s a difference but it can be a fine line. People can go for years abusing it and not be truly alcoholic, but sometimes the behavior is so similar that a distinction can’t really be drawn between the two.
Well, the term “disease” might have different implications for different folk. I do believe there is a genetic component that makes some people more attracted to mood altering substances, and more resistant to attempts to moderate/discontinue use.
There also is an emotional component - an addictive personality if you will. But then we have to discuss the extent to which one’s personality reflects nature, nurture, and/or preference.
It seems as tho much substance use/abuse is remediable/treatable - which may be consistent with the “disease” designation.
To use your friend’s definitions - are STDs "diseases? They are, after all, 100% avoidable…
I agree with the OP’s friend. No one wakes up one day with a bad case of alcoholism or heroin use, nor do you catch it from a friend. You consciously go out and drink too much or shoot up: it requires you to actively and persistently do something, and can be avoided by simply not doing that thing. That doesn’t sound very disease-like.
It’s funny how many people think that words are defined by what they think they should mean. This is especially true whenever a word is used in a technical fashion. Compare the attitude: “I think ‘disease’ should mean xxxxx” with “Well, Darwin’s Theory is just a guess, because that’s what ‘theory’ means”.
The definition of “disease” they’re invoking is pretty standard and jives with a cross-section of online dictionary definitions of the word.
The cultural norm is to assume that alcoholics are somehow just weak-willed. It’s easy to get hung up on the notion that if it’s a disease, then it somehow releases the afflicted of responsibility over their condition, even though they are non-related concepts.
I find it a bit offensive that some people think you can ‘control’ addiction. As a recovering alcoholic, I can say you most certainly can’t control youself. It takes a lot of willpower to stop, and stay stopped. Same goes for those who have drug problems, or those who smoke, or those who are problem gamblers.
In addiction, your brain chemistry changes. It’s very difficult to stop yourself. You rationalize everything, you make excuses, even if you know you’re making the wrong choice.
Is obesity a disease? Can people just ‘eat healthier and exercise’? Why is everyone so fat? Really, it’s common sense to eat properly, so why don’t people just do it?
Of course alcoholism and drug addiction are diseases (or perhaps more accurately, disorders that lead to physical diseases). Ones that aren’t easily understood by people who don’t suffer from them.
I’m not criticizing these folks-- I’m pointing out that it’s experientially impossible for non-addicts to comprehend addictive disorders because they’re not addicts.
For instance, I don’t suffer alcoholism. I drink occasionally, sometimes heavily (a few times a year), but I have no craving for alcohol on a regular basis, nor do I suffer any withdrawal worse than a morning hangover. Whatever addiction centers I may have in my brain, they are thankfully NOT triggered by alcohol.
I’ve never tried illegal drugs, so I don’t know if I’d be addicted. There are plenty of accounts of people who have used cocaine, for instance, who do not become addicted. They may like it, they may use it, but they can and do stop using it. That said, plenty = all, and some people are addicted from the moment they first try cocaine, and will stop at nothing, including their own ruin, to continue using it.
As you get into other classes of illegal drugs, the potential for addiction can increase even more, and may be different even for people not previously affected. For instance, you may not be an alcoholic, cocaine may not do a thing for you, but one hit of meth could change your life forever in a way you certainly won’t enjoy. These people won’t be doing meth because it feels good-- they’ll be doing it because they have to.
Beyond alcoholism, there are plenty of other disorders that disclose the brain going awry. Talk to anyone with OCD, for example, and they’ll tell you that it actually feels good to be OCD-- and it feels painful to NOT be OCD. They’re literally addicted to their OCD behavior, no matter how bizarre or stupid. That’s the brain at work.
So, you can have a thirty-beer weekend and not be an alcoholic. You can have one drink a night, however, and be one. It’s not a behavioral diagnosis-- it’s a biochemical disorder that is difficult to override.
Can if be overridden with willpower? Sure, obviously. But it requires a tremendous amount of willpower to do so, enough that in 2009, now that we have a better grasp on the science behind this, increasingly seems like willful cruelty to addicts. As we better understand the science here, we’ll find new ways-- perhaps pharmacologically, perhaps therapeutically-- that can eliminate the addiction, and allow addicts to live clean & sober again (or even actually function like you or I do-- have a beer again without risking their ruin).
“Just say no” does not now, nor has it ever, worked as a preventative or curative measure. “Simply not doing that thing” is a completely simplistic and unrealistic approach to the problem. It’s like telling someone who is clinically depressed to just be happy instead.
My family is riddled with alcoholism. It killed my father and nearly killed my brother. My son is presently in treatment for both oxycontin and alcohol dependency. The tendency to addiction has been shown to be an inherited trait. People who have had to deal with alcoholics (or who are alcoholics themselves) understand that the physical and mental NEED for that drink is overpowering and all-consuming.
My take? No, it’s NOT a disease… but if calling it a disease takes off a bit of the stigma, and allows people to seek treatment while preserving a trace of self-respect, I don’t see the harm in pretending.
Maybe an alcoholic or crack addict who tells himself, “I have a disease” will be more likely to enter rehab than one who thinks he’s just w worthless lush or junkie.
Even if I regard that as an illusion, it may be a helpful illusion.
That has to be one of the stupidest things I’ve ever heard. No offense to your friend, of course. But sheesh!
Who does she think classified it as such? Alcoholics? Yeah, they’re primarily concerned with getting treatment for a mere co-pay. Doctors? Yeah, we all know that they make a mint from treating addiction. Insurance companies?
As someone with serious allergies, I take offense at that comparison (although I’m sure you had no intention of offending). Allergy and addiction are two very different things, and I can’t tell you how tired I am of people diluting the word “allergy” by using it inappropriately. Not just for saying alcoholism is an allergy to alcohol, but also saying “I’m allergic” when what they really mean is “I don’t like this” or all the other countless variations. The result is that a lot of other people think allergies aren’t real or aren’t serious or just “preferences” which makes the life of the allergic much more difficult.
Think about the things people do and the things that happen to them as a result of alcohol. Going to work drunk? Spending the rent money on booze? Driving a car even though they’re seeing double?And they do it again and again, regardless of what consequences they may have faced in the past. How can a person who does these things not be considered to have a disease? If a person literally cannot stop themselves from a certain behavior, I’d say that person is ill. However, for the purposes of defining alcoholism I think we’d be better off finding another word for the condition. Many people share your friend’s view and bristle at calling it a disease because they don’t see substance abuse as a condition for which they can feel sympathetic.
I would assume the alcohol= disease approach started as a way to help those attempting recovery. Even though it isn’t a disease in the way most people interpret the word there is a component of the condition that is beyond the alcoholic’s control and perhaps that’s the word that comes closest.
Almost ANY disease can be prevented so her definition doesn’t make much sense. Heart issues–preventable, STD’s–preventable, Lung Cancer–preventable, Obesity–preventable, Sport related accidents–preventable etc.
All of these are caused by the deliberate actions of the person who has them aren’t they?
Whether alcoholism is a disease or not may be debated, but not by that definition or frankly there are a host of other ‘diseases’ which can’t be considered diseases. I rather doubt she would think any of the above as anything other then diseases–or does she consider say Lung Cancer as preventable and thus not a disease?
In addition there are a host of issues that come from being an alcoholic–liver issues, etc. Are those then not considered diseases by her? If I had liver disease because I drank too much that isn’t considered a disease, but if I got it via malnutrition it is? What if the malnutrition was created by the alcoholism? Is it a disease then?
I understand what you’re saying it, and why you’re saying it, but try this thought experiment.
You have to take showers, right? Keep clean, scrub behind the ears, shampoo your hair, the whole nine yards. Once a day, once a week, no matter, you’re going to clean yourself on a regular basis. Feels good to be clean, no dirt, no grime, no sweat, no smell.
Now, imagine everytime you finished taking a shower, you wanted another one. Sure, you just washed yourself, but you rubbed yourself down with a towel that’s been hanging in the bathroom since yesterday. You should have done that with a fresh towel, because now you’re dirty again. What’s the harm in taking another shower? Feels good to be clean, after all.
This starts to be a habit. One shower a day turns into two showers a day. Maybe three. Pretty soon, you’re exhausting the bank account and the hours in the day taking showers. Your skin is cracked and raw. Your hair is falling out. You look and smell like hell. . . which means you better take another shower, right?
I of course just described OCD to you. People suffering from OCD do many of the same normal things you do every day, normal stuff in your routine that you take for granted. Taking a shower isn’t a disease, after all. It’s a good thing, everyone can agree. But for some people, taking a shower-- or washing their hands, or rearranging their furniture, or touching doorknobs twice with each hand-- is the only way to relieve their symptoms. It doesn’t just feel good-- it’s a compulsion, an overriding demand to ignore everything else in life, even their own willpower, wisdom and rationality (most OCD suffers, for example, rationally know what they’re doing is stupid/bizarre/wrong), in order to satisfy their compulsive behavior.
Okay then. . . now, visit Ruby Tuesday’s and have yourself a Mudslide :).
The alcoholic does what you and I do every day, what we take for granted-- the ability to socially consume alcohol-- and instead of it being a choice, it becomes a compulsion. Their brain chemistry can’t handle it. Once exposed, they are addicted. Now, they might not “know” it yet-- alcohol is one of those things that may take a while to affect the brain chemistry, i.e. it may not be solely a genetic deal where you’re born an addict. With booze, you might have to “nudge” along your brain chemistry a bit. But again, that’s not hard-- after all, most people who drink alcohol AREN’T addicts, so most people have no trouble trying out alcohol. Alcoholics all started somewhere-- maybe binge drinking in college, maybe just a few cocktails after work. But enough exposure to the booze, and eventually, their brains click in a way that our brains don’t.
And then they’re just as trapped as my OCD shower guy. Trapped in a way that “normal” people aren’t.
Illegal drugs are like alcohol, only even better, because they affect the brain even more directly/powerfully/quickly than booze. Fundamentally, addiction to bourbon and addiction to meth is probably pretty close biochemically. The difference with meth is that the addict can become addicted immediately, whereas with booze it might take that aforementioned nudge. Also, something like meth is so powerful that it can literally make anyone an addict. I’m 34 years old, have drank a lot of alcohol over the years, but I’m confident that I’m not an alcoholic, and probably never would be. But taking meth hits would probably put even me under, given its power.
I reserve my moral judgments for drug dealers, not drug addicts. Should they never have tried drugs? Sure, of course. They made a mistake, a dumb mistake. But that one mistake isn’t to blame for their addiction-- biology is.
Anyway. . . labeling addiction as a disease is an inelegant solution given our historical understanding of disease as something you “catch”, not something that you provoke. But assuming that addiction is simply a moral choice (in part because some people have been lucky/fortunate enough to fight their addiction through pure moral willpower) is a scientifically ignorant position.
Absent the invention of a new word (I personally prefer “disorder”), disease works just as well.
Let’s go one better: diabetes. We all agree diabetes is a disease, right? We all agree it has a heritable component, even Type 2 diabetes.
But Type 2 diabetes can show up, or show up far earlier than normal, in patients who have poor diet and bad exercise habits. You can “trigger” Type 2 diabetes based on personal behavior.
Think of alcoholism as diabetes of the brain: not everyone’s brain will get it, just as not everyone gets Type 2 diabetes even after a lifetime of enjoying sweets and carbs. But those who are susceptible to the disease-- just like those who have a genetic history of diabetes-- will trigger it with their behavior, i.e. drinking alcohol.
Those are bad decisions, but not necessarily a disease. What about a person who makes repeated bad decisions that are not alcohol-related? Would you say that person is diseased?
There’s also the entire severity continuum, and different persons’ different responses.
At what point does a personality quirk become a diagnosable and treatable disorder? I suspect we all know some kids described as and medicated for ADHD whom we believe are simply the products of crappy parenting and would benefit from some structure and modelling. But I assume most of us also know kids who pretty clearly seem to require more than just good parenting.
Same way with drinking and drugs. What distinguishes between the heavy drinker and the alcoholic? I drank heavily for a long time, and tho I did not and do not consider myself an alcoholic, I believe I would have satisfied AA’s and just about everyone else’s definition of the term.
Of course I was able to stop on my own, through nothing more than willpower. So does that say something about whether or not I was an alcoholic, or does it say more about my underlying personality?
I believe there is a significant personality component to a person’s willingness/susceptability to overuse/abuse a substance, their acknowedgement of the impact of their choices/actions on their life, and their ability to control/cease their use. On a practical basis, does it make any real difference if I refer to someone as an addict, as opposed to someone with an addictive personality/tendencies?