Is alcoholism a dsease?

[Squink]

The fact that people are unaware of a better method, does not make this method GOOD.

Of course not. It may in fact be a BAD method, in whatever sense of the word you desire, but it is also the ONLY method available to many people.
It’d be nice to see some stats on whether there are other methods that work as well as AA, but I don’t have any; do you ? As usual, new ‘cures’ need to prove their efficacy before they are widely adopted.

The insistence of 12-step followers that if you follow the program to the T and it doesn’t work for you, or if you seek alternative methods it’s YOUR flaw also clouds the issue.

You’re objecting to the fact that the people for whom the program worked BELIEVE that it works ?
It’s a program based on changing a persons attitudes, not some Flu shot that works whether the patient believes it will or not !
As far as AA discouraging “alternative methods”, you need to consider that many people have tried many alternatives in the past, and none of them turned out to be very effective for very many people. That does not mean that someone won’t come up with something better than AA in the future. It does mean that the AA community is justified in it’s skepticism towards new approaches.

[ultrafilter]

*Originally posted by IzzyR *
**The question as I see it is if emphasizing the genetic aspects of it increase or decrease a person’s motivation to control it. **

What if I made the same statement, except that I switched the word “environmental” for “genetic”? Neither genes nor environment determine a person’s behavior, although both are strong influences. People can choose to overcome any influence, just keeping in mind that some are stronger than others.

[ChoosyChipsAndCeilingWhacks]

[QUOTE]
*Originally posted by MGibson *
**

Have they really proved that alcoholism is an inherited trait? So far as I understand it alcoholism does run in families. But is that because people are raised observing certain behaviors in their parents or because of some genetic predisposition? Child abuse also runs in families but I don’t think many people claim to be genetically predisposed.

Marc **

I don’t think they HAVE proven it. I agree with you…and I believe it’s really impossible to tell if certain things are genetically based, or created by the subject’s environment. For one thing, we know that behavior and environment can CAUSE genetic and other physical changes. Therefore, the genetic “predisposition” may not be a predisposition at all, but something the user has created in their own bodies due to their SOCIAL and emotional “predisposition.”

However, I also recognize that many people have a stake in proving that alcoholism is a disease the abuser is born with. And attacking research on the subject from THAT angle (“We know there is an alcoholism gene and therefore, we will set out to find it.”) will almost certainly produce a genetic culprit, whether there really is one or not.

And I assert that even when Dr. Itsnotyerfault comes up with his “conclusive” evidence that you were BORN an alcoholic, this does not mean that you have to live a life sentence of 12-step mumbo jumbo and be constantly in “treatment.” If you want to consider it a genetic anomally, so be it. But millions of genetic traits each year go undiagnosed as a “chronic disease.”

-L

[IzzyR]

*Originally posted by ultrafilter *
What if I made the same statement, except that I switched the word “environmental” for “genetic”?

Same thing.

[ultrafilter]

*Originally posted by IzzyR *
**

*Originally posted by ultrafilter *
What if I made the same statement, except that I switched the word “environmental” for “genetic”?

Same thing. **

So talking about any kind of influences is removing emphasis from personal responsibility? That’s probably true, but it lends itself to a sort of slippery slope that I don’t like. Whether there’s a danger of slipping down that slope is a subject for another debate, though.

[DoctorJ]

Have they really proved that alcoholism is an inherited trait? So far as I understand it alcoholism does run in families. But is that because people are raised observing certain behaviors in their parents or because of some genetic predisposition?

Marc:
My understanding is that twin studies have shown that identical twins are more likely to have alcoholism in common than fraternal twins, suggesting that there is a genetic factor over and above environment. (Someone cited the study in one of the other threads.) Many things that can be described as “genetic” (or, more accurately, “familial”) have not been linked to a specific gene yet.

Dr. J

[Ned]

Help me out here. If alcoholism is not a disease, if these youngsters were just foolish and irresponsible and lacking in willpower, why did they go to AA? And how were they harmed?

What other options are there? AA has had hegemony over alcohol abuse for so long that other options are only now surfacing. Try to find a treatment center that isn’t 12 step. The fact that people were trying to get their lives together and grasped for the most available and widely touted alternative hardly demonstrates its effectiveness. The only reasonable statistical studies repeatedly demonstrate that 12 step based programs are no more effective than no program at all.

I am certainly not suggesting that people with drug dependencies are just foolish and weak willed. I suspect that there are any number of factors that can lead to this sort of obsessive behavior. My disagreement is with the specific AA conception of the disease which serves, in my opinion, only the purpose of perpetuating AA as a growth organization.

Where AA harms is in propogating the junk science belief that mere strength of will is insufficient to deal with the problem. The idea that they will never be free of the urges intimidates many from trying at all. People who quit outside AA just quit by the way, they don’t obsess about it for the next 20 years. I have seen one study that correlated previous unsuccessful exposure to AA doctrine with lower future chances of a sober lifestyle.

Genetic studies are highly suspect for a number of reasons first of which being that correlations do not demonstrate causation. Twin studies do not show that high a correlation and even then it is a huge leap to postulate some sort of obsessive behavior gene. Inherited socially maladaptive traits could easily make one more suseptible to drug abuse. Hell, even left handedness is slightly correlated.

Lets also not forget the soft nature of the diagnosis in the first place. In my time at a very well respected treatment center I met a surprising numer of people who’s serious problems obviously had nothing to do with alcohol or drugs. Their doubts about the nature of their problems were often met with the ludicrous proposition that they wouldn’t be in a drug treatment center if they didn’t weren’t alcoholics. Many of them happily decided they were alcoholics just to fit in.

[Ned]

In the harm catagory I should have added psychological stress and cognitive dissonance. It sounds cute to say a soap dish can be your higher power but watch an intelligent person desperate for the help he is promised actually trying to make his mind accept this. It is a distressing thing to watch. While some are able to slide over all the mixed messages and logical contradictions AA puts forward others find it intensly disturbing to try to integrate it all. The stress for some was so palpable I would be very surprised if there were not after efects.

[SpoilerVirgin]

*Originally posted by Doctor Goo Fee *
Is alcoholism a disease?

Yes. From WebMD - Basic information about alcoholism - what is it, what causes it, and who is at risk.

Alcoholism is a chronic disease, progressive and often fatal; it is a primary disorder and not a symptom of other diseases or emotional problems. The chemistry of alcohol allows it to affect nearly every type of cell in the body, including those in the central nervous system. In the brain, alcohol interacts with centers responsible for pleasure and other desirable sensations. After prolonged exposure to alcohol, the brain adapts to the changes alcohol makes and becomes dependent on it. For people with alcoholism, drinking becomes the primary medium through which they can deal with people, work, and life. Alcohol dominates their thinking, emotions, and actions. The severity of this disease is influenced by factors such as genetics, psychology, culture, and response to physical pain.

If so, what causes it?

The craving for alcohol during abstinence, the pain of withdrawal, and the high rate of relapse are due to the brain’s adaptation to and dependence on the changes in its own chemistry caused by long term use of alcohol.
…
Research indicates that dopamine transmission, particularly, is strongly associated with the rewarding properties of alcohol, nicotine, opiates, and cocaine. Investigators have focused on nerve-cell structures known as dopamine D2 receptors (DRD2), which influence the activity of dopamine. Mice with few of these receptors show low interest in and even aversion to alcohol.

In people with severe alcoholism, researchers have located a gene that alters the function of DRD2. (Note: WebMD points out that other researchers have disputed these findings, and that research is continuing.)

Researchers are also investigating genes that regulate certain enzymes known as kinases that affect alcohol uptake in the brain as well as genes that affect serotonin. Even if genetic factors can be identified, however, they are unlikely to explain all cases of alcoholism. In fact, lack of genetic protection may play a role in alcoholism.

What cures it?

From WebMD - How to diagnose alcoholism - and then treat it with counseling or drugs.

The two usual forms of therapy for alcoholics are cognitive-behavioral and interactional group psychotherapy based on the Alcoholics Anonymous 12-step program.

A typical inpatient regimen includes a physical and psychiatric work-up, detoxification, treatment with psychotherapy or cognitive-behavioral therapy, and an introduction to Alcoholics Anonymous. Because of the high cost of inpatient care, its advantages over outpatient care are currently being questioned.

The article at WebMD goes on to discuss the various studies which have researched the efficacy of the different treatments. We have not found the cure for alcoholism any more than we have found the cure for cancer. But the fact that some individuals who receive chemotherapy (or radiation, or have surgery) do not recover does not make the treatment worthless, or make cancer any less of a disease.

AA may not ultimately be the answer, but at the moment it is the best treatment we have, and research into alternatives on a wide variety of fronts, including alternate 12-step programs, cognitive therapy, medication, and eventually gene therapy is continuing. CNN Presents did an episode this week about a treatment program combining therapy and medication which was not AA-based. For most participants, AA is voluntary. Those who choose this form of treatment are also free to seek alternatives, or to try to go it alone and “just quit” if that’s what they want.

As for the “dry drunk”, it is exactly the same thing as having a disease without any symptoms. It’s certainly possible to have any number of diseases without displaying symptoms either because they are dormant or because the symptoms are being treated.

I’m interested in those “hundreds of thousands or millions of people who have stopped drinking forever”. Do you have any evidence that large numbers of people have stopped drinking forever without the assistance of AA or other treatment programs? More importantly, were those people alcoholics as defined by the medical community? That’s the whole point of alcholism being a disease. For the non-alcoholic, it may very well be possible to give up drinking just by stopping, but for the alcholic, it is not.

[Wiwaxia]

*Originally posted by DoctorJ *
My understanding is that twin studies have shown that identical twins are more likely to have alcoholism in common than fraternal twins, suggesting that there is a genetic factor over and above environment. (Someone cited the study in one of the other threads.) Many things that can be described as “genetic” (or, more accurately, “familial”) have not been linked to a specific gene yet.

Certainly a link has been established between some genetic polymorphism and vulnerabilty to alcohol abuse, but as I stated in my post above, these links do not mean that alcohol abuse is a genetic disease, nor do they mean alcohol abuse is caused by repeats or certain configurations of these genes. A danger with genetic linkage studies is that it’s easy, especially for laymen, to misinterpret correlations as causal.

We also have to remember that it’s highly unlikely that we will ever find one specific gene linked to behaviours or disorders with a complex a nature such as alcohol abuse. Several different genes probably contribute to most conditions, and “post genetics” generally explain a larger part of the variance bewteen people than genetics.

(Btw, I’m sorry if my posts look messy, it’s the first time I post at this forum.)

[Dinsdale]

Let’s not overlook the political implications of labelling something a “disease.” Before placing too much weight upon the APA’s designition, we might ask how many years it has been since (at least portions of) the mental health community assigned that designation to homosexuality?

Social Security disability benefits used to be available to individuals based on substance abuse. When that was changed a couple of years ago, guess what happened? All those folks reapplied contending that their drug and alcohol use/abuse was merely a symptom of their underlying depression/anxiety/etc.

There is at least some element of “the chicken vs the egg.” For example, many alcoholics are depressed. Does one drink because he is depressed, or is he depressed because he drinks? Is a tendency towards alcoholism inheritable, or is the inheritable genetic predisposition a character/personality trait that makes that individual more susceptible to substance dependency/addiction?

[ChoosyChipsAndCeilingWhacks]

[QUOTE]
*Originally posted by SpoilerVirgin *
**

AA may not ultimately be the answer, but at the moment it is the best treatment we have…**

Treatment? Okay, I’m sorry if I’m beginning to sound a little harsh. But I (and several people I know) had exactly the experience with a 12-step program that Ned describes. I don’t care if WebMD calls it a disease. I don’t care if the Pope calls it a disease. The nature of “disease” is a matter of human definition. If Web MD or the Pope can come up with good research and facts, then I’ll consider changing my mind. But until then, I haven’t seen any research that indicates a disease status for alcoholism. It’s been defined and re-defined over time and will continue to do so. WebMD is not the definitive expert on the subject.

That said, back to the issue of what constitues “treatment.” In my opinion, “treatment” would be something that treats a problem. Involvement in a 12-step program in no way constitutes treatment. There is no one at ANY meetings who is an authority on the subject at hand. In fact, you could easily be at a meeting in which every participant is going to go home and abuse themselves immediately after the meeting. They don’t know the answer any better than you do.

You sit in a circle with others who are “ill” to varying degrees, and one by one listen to them tell their stories. Much of what they say has little or nothing to do with the problem at hand. It certainly has nothing to do with YOUR problem. Sure, if you’re lucky, someone will share an experience that might shed some light on your problems…something you can take home and use to help yourself. But you have to sit and listen to a lot of clueless desperate people ramble about their personal lives before you ever get anything even remotely useful. Of course, you might not be lucky and ever get to that useful information anyway.

Meanwhile, discussion is not allowed. No one is EVER able to comment, question, suggest, or otherwise have a discourse on their difficulties abusing themselves. It’s just a series of uninterrupted monologues that can be about ANYTHING the speaker wants to discuss. His dog, her abusive spouse, the last time he got drunk at a party. Anything.

In fact, no TREATMENT is offered or even HINTED at in the 12-steps. Sure, we admitted we were powerless. We made a list of persons we’d harmed. We sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out. Hell, we even convinced ourselves that if we weren’t into all this spiritual hocus pocus, we could (to use Ned’s example) pray to the soap dish to save ourselves.

But…here’s the fun part…which step is the one where we (gasp) quit drinking? (or quit taking drugs, or quit binging…)

Where’s the discussion on things to do to get your mind off of alcohol? Where’s the step where we change our thinking so that we crave healthy things? What about where we look into problems that might have caused the alcoholism, such as depression, and treat them? Where do we learn to care enough about ourselves that we find we’re worthy of taking care of?

Oh look. They’re missing completely.

Exactly what part of this plan involves actual TREATMENT of ANYTHING, disease or not? As far as I can see, it’s a support group of other abusers and not anything that even remotely resembles real treatment.

[wring]

“treatment” does not simply mean a certain number of pills. Treatment options for some diseases and conditions include counseling (individual and group), and the provision of educational materials, exercise, physical therapy etc. For example, if one is diagnosed with diabetes, the treatment may include such things as:

1. Insulin regime/medications
2. Educational materials on nutrition, the disease etc.
3. Introduction to other people living with the condition (to provide emotional support, day to day solutions for situations - as an example, when a friend had to start dialysis, the hospital arranged for some folks who’d been on dialysis for a while to come talk with him about issues like traveling, storage of materials etc.)

So, AA meetings easily fall into a ‘treatment’ option.

the fact that it failed to work for you should not be considered to be evidence that the idea is bunk. It’s a popular alternative because it does seem to help quite a few. (just the number of meetings available tells me that it’s practical use keeps on growing, which wouldn’t happen if it didn’t prove to be helpful for some). There’s a multitude of treatment options for high blood pressure, too. Does the fact that treatment option A didn’t work for person B mean that it doesn’t work at all?

To me, the disease model of alcoholism is a useful tool. it allows for both the alcoholic and the people around them to stop focusing on self control as a potential solution. IMHO for the alcoholic, it’s best if they treat it as a life long condition (vs. a specific disease - disease as you see by the OP often means that folks think in terms of ‘cure’).

[dragongirl]

I can’t say that I have spent as much time researching this subject as much as most of you, but my opinion is that alcoholism is not a disease at all. I believe it is an escape from the pressures and responsibilities that we all face every day.

I can speak with a certain authority on this. My mother has been an alcoholic for most of my life. I feel the only reasons for her drinking is because she was not satisfied with her life. She came from a well off family and married a man who was not well off. They moved far away from her family closer to his. She was unhappy from day one. She made it a point to criticise(sp?) everyone and everything. She never tried to change her situation, no one was ever mean to her, and she never had to suffer in any way. She was simply a spoiled brat.

It never change when she had children. As we were growing up she put us in a lot of danger. It is a miracle that she didn’t hurt us phycally. Only emotionally.

I am not married , I have children. I am also at a risk of becoming an alcoholic. I do drink socially, but have never had a problem. I care too much about my children to ever put them in the danger I was in.

I have had to suffer in ways my mother never did. I have been in situations that I don’t wish on anyone. But I never turned to anything but my own inner strength. For that reason I feel that it is a weekness of personality not a disease. Alcoholics simply need to deal with their lives in a responsible manner and stop making excuses.

Just my two cents.

[Lucky]

Usually, one does not make a distiction between “true” or “not true” alcoholists

(bolding mine)

I love this term. It brings a certain air of sophistication to getting shit-faced.

“Stinking drunk!”

“No, no—I’m an alcoholist.”

The preformance art possiblilities are endless.

[Moirai]

SexyWriter, I don’t want to quote your whole post because it’s annoying and takes up too much space (the quoting, not your post!).

But a few observations-

My experience with AA had been diametrically opposed to yours. Does that make me right or wrong? No discussion? Wrong, we have lots of it. No acceptance of other treatment options? Bullshit, it happens all the time.

WebMD may not be the definitive authority on what constitutes a disease, but I’m pretty sure the American Medical Association is. They classified alcoholism as a disease backin the 1960’s (sorry no link, I am having computer problems, but that’s probably where WebMD got their info).

I am an authority on the subject at hand in a meeting. I am an alcoholic. I have more experience with this than any psychologist who is not an alcoholic.

From SexyWriter’s post-

"Where’s the discussion on things to do to get your mind off of alcohol? Where’s the step where we change our thinking so that we crave healthy things? What about where we look into problems that might have caused the alcoholism, such as depression, and treat them? Where do we learn to care enough about ourselves that we find we’re worthy of taking care of?

Oh look. They’re missing completely."

No, they are not. The discussion of things to do other than drinking happen every day. The step where we change our thinking? Step twelve, and the process inherent int he other eleven. Looking at problems and causes? Steps four through twelve. Learning to care about ourselves? It’s a process, not a magic pill.

I am sorry that your OA experience soured you on this aspect of recovery.

There are indeed many options for recovery, despite what Ned said. But AA seems to be “where the action is.” By that, I mean that I tried everything else before AA, who wouldn’t? But I found no women with long-term sobriety in the non-12-step programs, and I needed to know that people had gone before me and that it worked for them, otherwise why bother?

[SpoilerVirgin]

dragongirl -

I’m sorry for your experiences. Having to grow up with an alcoholic parent is a tragedy. If you haven’t already read it, I highly recommend the book “Drinking: A Love Story”. It may give you some more insight into what is going on with your mother.

Yes, alcoholism is an escape from the pressures and responsibilities that we all face every day. So are numerous other psychological disorders. That does not make it any less a disease. And your ability to live without alcohol is not evidence that your mother is nothing more than a spoiled brat. The fact that you drink socially and never have a problem indicates that you are not an alcoholic, not that your mother isn’t.

SexyWriter -

EJsGirl refers to your participation in OA. I think this is correct, as I remember your mentioning this in another thread. If that is the case, then let me just say that OA is NOT AA, and that I personally do not believe that the 12-step model is appropriate for treatment of obesity, nor do I believe that obesity in and of itself can be classified as “a primary disorder and not a symptom of other diseases or emotional problems” in the way that alcoholism is. If your assessment of all 12-step programs is based solely on experience with OA, then I can certainly understand your feelings, but I do not think that your reaction to OA can be applied to AA.

The bottom line is that AA involves NOT DRINKING, PERIOD. The program can focus on emotional healing because it doesn’t need to lay out specific steps for not drinking – you simply don’t. The same methodology cannot be applied to obesity/food issues. People have to eat, and therefore they DO need guidance in the specifics of how to move from unhealthy to healthy eating, something which the 12-Step model does not supply. This is why I think that food addictions require a different form of treatment.

[Doctor_Goo_Fee]

Golly-- I must say, I’d be a little reluctant to treat such a serious ‘disease’ with only the help of an organization of self-described chronically ill amateurs.

Maybe it’d be better to leave it to healthy professionals. (And not the opportunistic types who simply recite pseudo-religious mish-mash, extract your money, then hand you over to the above-mentioned amateurs for more of the same.)

I’ve often heard AA’ers say something like, “You can be too smart for it to work, but you can’t be too stupid.”

What the hell kind of person would entrust an organization that practically makes stupidity a membership requirement with the treatment of such a serious ‘disease’?

[Doctor_Goo_Fee]

Spoler Virgin wrote:

“…I’m interested in those “hundreds of thousands or millions of people who have stopped drinking forever”. Do you have any evidence that large numbers of people have stopped drinking forever without the assistance of AA or other treatment programs?..”

I have evidence, but not proof. It is reasonable to expect that the numbers are large. People have had serious drinking problems for thousands of years. Before AA existed the only way to cure your drinking problem was to simply stop drinking for good. (Many people still find this the best way.) Given the number of alcoholics over the years, combined with the compelling reasons for many of them to quit, and the success rate of folks who nowadays quit without AA… thousands or millions may be an under-estimate.

Spoiler Virgin also wrote:

“…More importantly, were those people alcoholics as defined by the medical community? That’s the whole point of alcholism being a disease. For the non-alcoholic, it may very well be possible to give up drinking just by stopping, but for the alcholic, it is not.”

The “alcoholic” quits drinking exactly the same way the “non-alcoholic” does–by refraining from transporting the ethyl through the lips, to the tummy.

Generally, I find that by “the medical community” 12-Steppers mean the “12-Step community” be they medical or otherwise. In Groups I’ve attended, AAers’ definition of alcoholics was “anyone working the program.” Conversely, anyone who stopped drinking without the blessings of AA was either on the short track to death or never an alcoholic to begin with.

This is one of the single most callous and ridiculous beliefs of the Group. To suggest that all the alcoholics who have successfully cured themselves without any of the self-defeating 12-Step mumbo-jumbo are in any way inferior to alcoholics who never get well and are merely ‘holding on’ day by day, or to suggest that their problems, now overcome, were in any way less serious then the Group-Steppers is so insultingly unfair.

What a childish and dangerous game AA plays-- “You can only be truly sick if you follow our path to recovery, or if you die.”

And doubly dangerous for the fact that their “path to recovery” not only never, ever, gets you there, but you have to surrender your free-will and responsibility along the way-- for the rest of your life.

[DoctorJ]

I think all this arguing over whether or not alcoholism is a disease is straining at gnats. It depends entirely on what you call a disease, and what you think “disease” implies. A better place to start would be defining alcoholism as you understand it.

Here’s my own operating definition: an alcoholic is a person who has a need to drink alcohol that interferes with his or her daily living. Note that in my definition, someone who has stopped drinking but who still thinks about drinking all the time is still an alcoholic, which would seem consistent with AA’s view. This is why I can’t agree with those who say, “All an alcoholic has to do to cure himself is stop drinking.” Then what?

At that point, you might tell the patient to just admit to himself that the desire is there, and that he doesn’t have to listen to it. You might even tell him to take it one day at a time. Then you might suggest some things he can do to start getting his life back in order. Those things are dangerously close to the methodology of AA, minus some religious overtones and jingoism.

Some people have told me that the desire to drink eventually went away. This would be inconsistent with AA’s once/always view. Even so, just because the desire went away in some people doesn’t mean it can go away in all of them.

Alcoholism is a condition with serious physical and psychological aspects that some people are clearly more susceptible to than others. Call it a disease if you want–that’s fine. Some will use that designation as a crutch, others will use it to stop beating themselves up, others will forcefully reject it. Just remember that it’s just a word that can connote different shades of meaning to different people.

As an aside, I’m forced to wonder if those who say alcoholics should “just stop drinking” are the same people who say depressed people should “just cheer up”, or that kids with ADHD “just need their little asses beat” or “just need to stop watching so much TV”? Just a thought. With psychiatry teetering on the edge of some breakthroughs (IMO), the next few decades are going to require a serious re-adjustment in our rigid separation of the mental and the physical.

Dr. J