# Once an alcoholic, always an alcoholic? **URL:** \ **Category:** Great Debates\ **Created:** [August 11, 2011, 2:49am UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291 "2011-08-11T02:49:12Z")\ **Posts on this page:** 20\ **Page:** 17
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 18, 2011, 5:42pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/322 "2011-08-18T17:42:12Z")
> [@Fear\_Itself](#): > > Alcoholism has a very low cure rate, no matter who is treating it. That does not mean it is not a disease. The same is true for depression. Some people are cured by doctors and medication; many people are not. Some people are cured by alternative treatments that are self prescribed; many are not. > > I don’t understand why you are so hung up on this false dilemma about curable/incurable, disease/not disease, etc. . Mental illness is squarely in the excluded middle. We might as well be arguing whether light is a particle or a wave; it’s two mints in one. And who is qualified to diagnose this incurable disease? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 18, 2011, 5:44pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/323 "2011-08-18T17:44:46Z")
> [@Czarcasm](#): > > And who is qualified to diagnose this incurable disease? Doctors and patients, of course. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 18, 2011, 5:51pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/324 "2011-08-18T17:51:20Z")
An untrained patient who has self-diagnosed her/himself as having an incurable disease goes to a support group of untrained amateurs who have done the same. Shouldn’t a trained professional of some sort or another be involved somewhere in this process? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 18, 2011, 5:52pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/325 "2011-08-18T17:52:47Z")
> [@Czarcasm](#): > > Shouldn’t a trained professional of some sort or another be involved somewhere in this process? It would have little impact on the outcome. ---
**Author:** ![RedFury](https://avatars.discourse-cdn.com/v4/letter/r/ec9cab/32.png) [@RedFury](https://boards.straightdope.com/u/RedFury)\ **Post date:** [August 18, 2011, 5:54pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/326 "2011-08-18T17:54:46Z")
> [@Czarcasm](#): > > An untrained patient who has self-diagnosed her/himself as having an incurable disease goes to a support group of untrained amateurs who have done the same. Shouldn’t a trained professional of some sort or another be involved somewhere in this process? You’re forgetting that they have a Higher Power ultimately taking care of things. Can’t get more professional than that. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 18, 2011, 6:00pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/327 "2011-08-18T18:00:21Z")
> [@RedFury](#): > > You’re forgetting that they have a Higher Power ultimately taking care of things. Can’t get more professional than that. I have to admit I am having a hard time understanding this reluctance to discuss the actual premise of this thread. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 18, 2011, 6:03pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/328 "2011-08-18T18:03:03Z")
> [@Czarcasm](#): > > I have to admit I am having a hard time understanding this reluctance to discuss the actual premise of this thread. I am reluctant to allow you to frame the the debate in such a way that your opinion is the only conclusion. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 18, 2011, 6:07pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/329 "2011-08-18T18:07:46Z")
> [@Fear\_Itself](#): > > I am reluctant to allow you to frame the the debate in such a way that your opinion is the only conclusion. If you wish to start a debate on a topic other than the one stated in the OP, you are more than welcome to do so. ---
**Author:** ![Malthus](https://avatars.discourse-cdn.com/v4/letter/m/85f322/32.png) [@Malthus](https://boards.straightdope.com/u/Malthus)\ **Post date:** [August 18, 2011, 6:09pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/330 "2011-08-18T18:09:46Z")
We have been through this before. [http://boards.straightdope.com/sdmb/showthread.php?t=582434&page=6&highlight=alcoholic](http://boards.straightdope.com/sdmb/showthread.php?t=582434&page=6&highlight=alcoholic) The scientific evidence appears to be that AA “works”, but there is no conclusive evidence that it “works” any better than other methods; and it would appear that it mostly “works” by providing a support network. Cites: > **[Rates and predictors of relapse after natural and treated remission from...](https://pmc.ncbi.nlm.nih.gov/articles/PMC1976118/?tool=pmcentrez)** > > This study examined the rates and predictors of 3-year remission, and subsequent 16-year relapse, among initially untreated individuals with alcohol use disorders who did not obtain help or who participated in treatment and/or Alcoholics Anonymous... > [@](#): > > Our findings on the benefits of relatively rapid entry into treatment and/or AA support the value of strengthening the referral process for individuals who recognize their alcohol problems and initiate help-seeking. Assessment of help-seekers’ motivation and readiness for change may help target high-risk individuals for interventions to enhance and maintain participation in treatment [57]. In addition, identification of risk factors for relapse after either treated or untreated remission can help providers target tertiary prevention efforts. > **[Alcoholics anonymous involvement and positive alcohol-related outcomes:...](https://pubmed.ncbi.nlm.nih.gov/12699024/)** > > A positive corelation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The... > [@](#): > > A positive corelation between Alcoholics Anonymous (AA) involvement and better alcohol-related outcomes has been identified in research studies, but whether this correlation reflects a causal relationship remains a subject of meaningful debate. The present study evaluated the question of whether AA affiliation appears causally related to positive alcohol-related outcomes in a sample of 2,319 male alcohol-dependent patients. An initial structural equation model indicated that 1-year posttreatment levels of AA affiliation predicted lower alcohol-related problems at 2-year follow-up, whereas level of alcohol-related problems at 1-year did not predict AA affiliation at 2-year follow-up. Additional models found that these effects were not attributable to motivation or psychopathology. The findings are consistent with the hypothesis that AA participation has a positive effect on alcohol-related outcomes. > **[Social networks as mediators of the effect of Alcoholics Anonymous - PubMed](https://pubmed.ncbi.nlm.nih.gov/12133128/)** > > The type of social support specifically given by AA members, such as 24-hour availability, role modeling and experientially based advice for staying sober, may help to explain AA's mechanism of action. Results highlight the value of focusing on... > [@](#): > > FINDINGS: In the structural equation model, AA involvement was a significant predictor of lower alcohol consumption and fewer related problems. The size of this effect decreased by 36% when network size and support for drinking were included as mediators. In logistic regression models predicting abstinence at follow-up, AA remained highly significant after including social network variables but was again reduced in magnitude. Thirty-day abstinence was predicted by AA involvement (OR=2.9), not having pro-drinking influences in one’s network (OR=0.7) and having support for reducing consumption from people met in AA (versus no support; OR=3.4). In contrast, having support from non-AA members was not a significant predictor of abstinence. For alcohol-related outcomes other than abstinence, significant relationships were found for both AA-based and non-AA-based support. > > CONCLUSIONS: The type of social support specifically given by AA members, such as 24-hour availability, role modeling and experientially based advice for staying sober, may help to explain AA’s mechanism of action. Results highlight the value of focusing on outcomes reflective of AA’s goals (such as abstinence) when studying how AA works. > **[Participation in Treatment and Alcoholics Anonymous: A 16-Year Follow-Up of...](https://pmc.ncbi.nlm.nih.gov/articles/PMC2220012/?tool=pmcentrez)** > > This study focused on the duration of participation in professional treatment and Alcoholics Anonymous (AA) for previously untreated individuals with alcohol use disorders. These individuals were surveyed at baseline and 1 year, 3 years, 8 years, ... > [@](#): > > When we found significant independent associations between 1-year duration of treatment or AA groups and 16-year outcomes, we conducted follow-up logistic regression analyses to examine differences between individuals who had no treatment (or AA) and those who obtained different durations of treatment (or AA). Individuals who received 27 weeks or more of treatment in the first year were more likely to be abstinent and less likely to have drinking problems at 16 years than were individuals who remained untreated in the first year (Table 3). Compared to individuals who did not enter AA in the first year, individuals who participated in AA for 9 weeks or more had better 16-year alcohol-related and self-efficacy outcomes (Table 3). Some of these differences were quite substantial; only 34% of individuals who did not participate in AA in the first year were abstinent at 16 years, compared to 67% of individuals who participated in AA for 27 weeks or more. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 18, 2011, 6:14pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/331 "2011-08-18T18:14:43Z")
> [@Czarcasm](#): > > If you wish to start a debate on a topic other than the one stated in the OP, you are more than welcome to do so. I don’t think you are the sole arbiter of what the topic in the OP is, nor do you get to define what is or is not a disease. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 18, 2011, 6:20pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/332 "2011-08-18T18:20:33Z")
> [@Fear\_Itself](#): > > I don’t think you are the sole arbiter of what the topic in the OP is, nor do you get to define what is or is not a disease. I think the OP has already said what the topic of debate is, and I am willing to let trained professionals decide whether or not someone has a disease. Fair enough? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [August 18, 2011, 6:25pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/333 "2011-08-18T18:25:17Z")
> [@Czarcasm](#): > > I think the OP has already said what the topic of debate is, and I am willing to let trained professionals decide whether or not someone has a disease. Fair enough? I reject that premise with respect to alcoholism, as well as for most mental illness. ---
**Author:** ![pinkyvee](https://avatars.discourse-cdn.com/v4/letter/p/6de8d8/32.png) [@pinkyvee](https://boards.straightdope.com/u/pinkyvee)\ **Post date:** [August 18, 2011, 6:36pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/334 "2011-08-18T18:36:42Z")
> [@Czarcasm](#): > > Is that a refusal to commit to an actual answer? If alcoholism is a disease, is it o.k. to self-diagnose this disease, and if so what other diseases fall into this category? Well, let me say that there are certain symptoms of the disease of alcohol abuse that do need medical diagnosis as well as medical intervention. Most of these occur towards the end zone of the alcoholic spectrum. For instance, alcoholic cirrhosis. I’ve never met a lay person able to self diagnos this result of their drinking. Same with alcoholic dementia, Wernicke-Korsakoff syndrome. There are many other end stage sequela I have not mentioned. These diagnoses are not left to lay person speculation. It’s not difficult for a patient (or even a family member) to self-diagnose the fact that their life is chaotic, their personal and professional relationships are in ruins and that the most likely cause is their obsession with alcohol. Other diseases? Depression. Many people will recognize there is “something wrong” with them. They know they feel sad & depressed & hopeless. And, many times they will self diagnose depression before seeing a physician. They are usually correct, in my experience. But, a physician might ask the depression scale questions anyway. Mostly to determine the severity. People might not even go see a physician, but look stuff up on sites like Web MD, and begin some simple life style treatments, such as exercise, etc. If simple life style changes and self care actually make things better and the person improves, then how is that a bad thing? On a personal note, my father in law died of alcoholic cirrhosis. He lived in denial of his alcoholism to the bitter end. A little “self diagnosis” on his part would have been a good thing. It’s called personal insight. **AA members self identify, they do not self diagnose.** ---
**Author:** ![OneMissedPost](https://avatars.discourse-cdn.com/v4/letter/o/8e7dd6/32.png) [@OneMissedPost](https://boards.straightdope.com/u/OneMissedPost)\ **Post date:** [August 18, 2011, 6:42pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/335 "2011-08-18T18:42:48Z")
> [@Fear\_Itself](#): > > Doctors and patients, of course. Haha, what?! You are saying patients are able to diagnose?! > [@Fear\_Itself](#): > > I reject that premise with respect to alcoholism, as well as for most mental illness. Haha, what?! You reject the premise that professionals cannot diagnose mental illnesses?! This debate isn’t even logical anymore. People cannot admit when they are wrong and just continue to make up stuff… Nice. ---
**Author:** ![OneMissedPost](https://avatars.discourse-cdn.com/v4/letter/o/8e7dd6/32.png) [@OneMissedPost](https://boards.straightdope.com/u/OneMissedPost)\ **Post date:** [August 18, 2011, 6:52pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/336 "2011-08-18T18:52:56Z")
> [@pinkyvee](#): > > **AA members self identify, they do not self diagnose.** Cite please? Are you going to keep providing anecdotal evidence or are you actually going to provide a cite? ---
**Author:** ![gurujulp](https://avatars.discourse-cdn.com/v4/letter/g/ba9def/32.png) [@gurujulp](https://boards.straightdope.com/u/gurujulp)\ **Post date:** [August 18, 2011, 6:53pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/337 "2011-08-18T18:53:20Z")
> [@Czarcasm](#): > > I think the OP has already said what the topic of debate is, and I am willing to let trained professionals decide whether or not someone has a disease. Fair enough? What about people who don’t have insurance? Who can’t afford or don’t wish to go to a doctor to be diagnosed? What is the problem with AA as a self help group for people who want to help themselves? Let us presume that NO ONE can diagnose alcoholism, unless what is referred to is chemical dependance on alcohol, which is easy to see- person has physical withdrawal symptoms without alcohol… Presuming that, then it is all just people behaving well or poorly, and they can treat the symptoms or not, and it doesn’t matter whether they call it alcoholism, the attack of the pink elephants, or being thirsty for a poison- if they want to go to AA, and the people in AA want to tell them they are sick, or well, or not, who cares? If and until it happens to YOU as an individual, why do you care? The OP cares, and has raised the question as to whether he should be labeled an alcoholic. Most people believe that if you have to ask the question, you probably have a problem. The OP doesn’t wish to believe this, and so far, the common trend seems to be that if he can live his life and drink, then cool, if he can’t then he should stop drinking. In my experience, in the pages of the literature of AA, and in the testimony of people here, that is also what AA says; “If you can drink and live well, then that is great! If you can’t drink and live well, then you might be like us- and this is what worked for some of us.” What is the problem that you are having with this? Do you have a problem with someone self diagnosing schizophrenia because they are seeing and hearing things they know aren’t there? Most psychiatrists will accept someone’s statements in regards to this. In fact, schizophrenia is diagnosed by asking people questions and giving them tests in which they tell the doctor what they think, see, hear, and believe. In a sense, all mental illness is self-diagnosed, unless one gets into psychiatric states where communication isn’t possible… ---
**Author:** ![OneMissedPost](https://avatars.discourse-cdn.com/v4/letter/o/8e7dd6/32.png) [@OneMissedPost](https://boards.straightdope.com/u/OneMissedPost)\ **Post date:** [August 18, 2011, 6:56pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/338 "2011-08-18T18:56:29Z")
> [@gurujulp](#): > > Let us presume that NO ONE can diagnose alcoholism, unless what is referred to is chemical dependance on alcohol, which is easy to see- person has physical withdrawal symptoms without alcohol… Oh my word… If no one can diagnose alcoholism, alcoholism would not exist. C’mon now! :smack: If we presumed that, we wouldn’t even have a debate anymore. ---
**Author:** ![OneMissedPost](https://avatars.discourse-cdn.com/v4/letter/o/8e7dd6/32.png) [@OneMissedPost](https://boards.straightdope.com/u/OneMissedPost)\ **Post date:** [August 18, 2011, 6:59pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/339 "2011-08-18T18:59:25Z")
> [@gurujulp](#): > > In a sense, all mental illness is self-diagnosed, unless one gets into psychiatric states where communication isn’t possible… WRONG. Mental illnesses are not self-diagnosed. If mental illnesses were all self-diagnosed, there would be no need for psychologists and psychiatrists. While you are at it, you might as well come up with an argument why we do not need psychologists and psychiatrists. I guarantee that if you start with the premise that all mental illnesses are self-diagnosed, you will be laughed at endlessly. ---
**Author:** ![gurujulp](https://avatars.discourse-cdn.com/v4/letter/g/ba9def/32.png) [@gurujulp](https://boards.straightdope.com/u/gurujulp)\ **Post date:** [August 18, 2011, 8:01pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/340 "2011-08-18T20:01:32Z")
> [@OneMissedPost](#): > > WRONG. Mental illnesses are not self-diagnosed. If mental illnesses were all self-diagnosed, there would be no need for psychologists and psychiatrists. While you are at it, you might as well come up with an argument why we do not need psychologists and psychiatrists. I guarantee that if you start with the premise that all mental illnesses are self-diagnosed, you will be laughed at endlessly. Okay. I will ask my PhD Psych wife to see if she wants to waste some time attempting to fight your ignorance, but I doubt she wants to spend her time that way. ---
**Author:** ![OneMissedPost](https://avatars.discourse-cdn.com/v4/letter/o/8e7dd6/32.png) [@OneMissedPost](https://boards.straightdope.com/u/OneMissedPost)\ **Post date:** [August 18, 2011, 8:18pm UTC](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291/341 "2011-08-18T20:18:16Z")
> [@gurujulp](#): > > Okay. I will ask my PhD Psych wife to see if she wants to waste some time attempting to fight your ignorance, but I doubt she wants to spend her time that way. What ignorance? You said that all mental illnesses are self-diagnosed? Prove it. No, I’d rather you take the time to actually find a cite to backup your claims. No, I don’t want to hear what your wife has to say. I want to hear what you have to say. Spend time finding cites for a good debate. Do some research. You do not debate by saying your wife has a PhD. What does that have to do with our debate? [Previous page](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291.md?page=16) [Next page](https://boards.straightdope.com/t/once-an-alcoholic-always-an-alcoholic/592291.md?page=18)