The disease of alcoholism...
 

I was watching the morning news and they started talking about the Miss America woman that Trump almost took over her crown from...well, she just left rehab and she says something to the affect of: "And yes, I do suffer from the disease of alcholism."

I know that alcholism is rough...it destroys lives and ruins relationships. But, is it a disease? I need the thoughts of the doctors and others to help me out here. I have heard it referred to as a disease for a while but in my uneducated mind, I have never thought of it as a disease. I see it as an addiction. Am I wrong and is it really a disease? Just wondering what everyone's thought was on this.

It's a definitional problem, but the problem with disease definition for alcoholism is it tends to eliminate personal responsibility when most of the treatment requires the addict to regain control abdicated through the syndrome.

alcoholism is thought of as a disease that someone may have, even if they have been sober for many years. Adoption studies have shown that some people have genetic risks associated with becoming alcoholics. Why is one person able to stop drinking and another not?

One of the most common treatments for alcoholism is Alcoholics Anonymous. They consider alcoholism to be a permanent state, and they certainly don't try to eliminate personal responsibility.

You know better than I. But it is consistent with my client who treats a large number of Clark County's alcoholics and drug abusers.

It is a permanent condition that someone subject to cannot never overcome except through total abstinence. AA does a great job of helping many addicts.

I remember a while ago (10 plus years) Tommy Lasorda was discussing Darryl Strawberry's problems with alcohol and drug abuse and someone asked him about Strawberry's sickness and Lasorda very emphatically replied that Darryl did not have a sickness, he had a weakness...which I thought was an interesting take.

I have a friend who was in AA by the time she was 20 or 21 after multiple DUIs etc...and I've seen how that has impacted her life and it has made me pause and wonder if it is a sickness or a weakness or if at some point humans are just naturally chemically wired to allow our weaknesses become addictions and subsequently sicknesses (Alchohol, drugs, porn etc..)

Great post, which also leads to the question in my mind: Can a weakness be a disease or the other way around?

I'm firmly in the camp that many will use the disease wording as a route to abdicate them from personal choice, accountability and responsibility, but having said that, at the same time I admit that I'm not sure if it IS a disease or not. Having never been in their shoes it's very hard to say.

It would be interesting to see how other addictions would be treated if those who were addicted treated each like a disease and said, " I can't help it, I have a disease." Like Pornography for example.

disease
noun
1. 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.

Do genetics play a role in alcoholism? the answer is a very clear "yes".

Is the brain incorrectly functioning when someone is dependent on alcohol? the answer is again yes. You can die of delirium tremens if you come off alcohol too fast.

Is alcoholism something that can be medically treated? yes. There are medications to allow someone to safely detox. There are also medications designed to help prevent relapse.

Don't argue that alcoholism isn't a disease in polite, educated company. Especially if they know you are Mormon.

Oh please. You make it sound as though the disease model were universally accepted and agreed upon by everyone. If you had even a single course on substance abuse in your training you should know that's hardly the case.

I personally think it's more complicated than just calling it a disease, or not calling it a disease. My experience has been that our culture's present love affair with finding a genetic link for every possible piece of distress that a human being can experience is definitely a double edged sword, if not an exercise in blatant reductionism.

Did you know that eating disorders are now also being called a disease?

Thanks for making my point. You just admitted that you wouldn't argue that it is not a disease, but that it is some middle ground. Because you know if you were to straight out argue that alcoholism has no application to the definition I introduced, you'd be laughed straight back to the Analytic Institute.

There are plenty of folks who don't believe in the disease model of the brain. Some of these we call psychologists. The types that argue bad moms cause schizophrenia. They are gradually going the way of the do-do bird.

I just read this descripton of alcoholism. It's not terribly scientific, but brings up a useful analogy.

Would one argue that Obsessive-Compulsive Disorder is not a disease? I'm wondering if there are still strains of academia out there that would make this argument.

I would make one other point. To say that Alcoholism has in some part a genetic basis for many people is not to make a deterministic statement. I think people get upset because they think that we are trying to say that there is an inevitablility about it, that there is no choice. Nothing could be further from the truth.

Science tells us that people with equal risk exposures, that have specific susceptibility genes, are much more likely to become alcoholics. That is, to use alcohol in a destructive way.

Even if you don't have this genetic susceptibility, you may end up an alcoholic. Alcohol, very clearly, has a terrible impact on the brain when used in large amounts. Acute intoxication can kill. Chronic intoxication can be reinforcing, leading to larger and larger amounts. It alters behavior--people lose their jobs and relationships due to excessive time and energy dedicated to drinking. It alters your brain cells, it alters the receptors on your brain cells, it can lead to seizures and death.

We find it useful, in medicine, to think of this as an actual condition where treatment can be useful. We know what causes it, we know what can treat it. In such cases, these conditions are called diseases.

Let's look at a different kind of example:
asbestosis def. Fibrosis of the lung as a result of the chronic inhalation of asbestos fibres.

We sure know this is preventable. A toxic substance has been ingested. It alters the body and causes dysfunction. It leads to medical treatment. We call it a disease.

Nice try, but your intentional mischaracterization of my argument and attack of my profession just makes you look silly. I have yet to meet a single person in my field that actually believes the things you just offered as a nice straw man argument to my point.

It would be just as easy for me to say, "There are plenty of folks who look only to the brain to explain all human distress. Some of these we call psychiatrists. The types that throw medications at everything and that argue bad chemical balances actually cause all emotional pain. They have gradually lost complete touch with the reality of human existence and medicalized everything to the point that their only existing niche is the severely mentally ill; no one else with half a brain will see them."

The disease model of alcoholism, of anything, is not without serious argument. The argument is that 'disease' hardly captures it, and only looks at one part of a complicated picture. The practical implications of calling something like that a disease are sketchy at best, counter to recovery at worst. The disease model, therefore, is woefully inadequate, and is mostly attributable to the pervasiveness of the medical model in our culture.

By the way, if you want to respond and discuss this in an intelligent manner, I'd love to. I very much enjoy these kinds of discussions. But if you want to arrogantly presume a high and mighty stance and mock my profession, then I'm not the one with my head in the sand.

you could start by defining "disease" and then arguing how it doesn't fit your definition.

as I have.

if you are going to say that the disease model doesn't account for the nuances of human experience, I am not going to agree with you. That would be your straw man.

If your argument that psychiatrists only see the severely mentally ill is true, then the explanation for that would be that the mentally ill are being treated by their family doctors. I don't think you can make a cogent argument that the disease model of mental illness isn't taking over in the United States. You are arguing the opposite?

You are doing everyone a disfavor by implying that thinking alcoholism ISN'T a disease is any way shape or form mainstream thinking.

Even AA says that drinking is not a choice for these people.

Powerless. Is that powerlessness useful to conceptualize in the disease model, such that we pursue medical treatments? It will be the very small minority that says "no."

So small that I doubt their numbers exceed those that believe schizophrenia is the result of upbringing.

Here is a psychologist who is a proponent of the idea that alcoholism is not a disease.

http://www.peele.net/7tools/index.html

I can't tell what his exact argument is. This may be it:

http://www.peele.net/lib/vaillant.html

This is the sort of straw man that psychologists of this particular ilk like to throw out.

What I don't particularly care for is the notion that one can generalize from a patient that comes into therapy once a week, to an entire condition or population.

The guy who comes in once a week
1) probably has a car
2) can afford the therapy
3) can afford the car
4) is highly motivated to get better
5) highly amenable to therapists direction/redirection

And then suddenly it becomes "you don't need medication" "you don't need AA" "just follow my therapy program."

Whereas the psychiatrst deals with this person described above, as well as the guy who has been brought in my police, is mad drunk, is screaming and cursing you, and requires medication to not go into a seizure.

In other words, we see people that do not seek treatment, and do not want treatment. and have had a much more severe course.

Why is that psychiatrists will say that Peele's approach of using therapy isn't wrong and will probably work just fine with a subset of patients, but Peele would say that the medical model is completely wrong, and no one should be on medication?

Psychiatry accepts both medical and non-medical models. Whereas guys like Peele are zealots and only accept the non-medical.

I have a question:

For me, a nonphysician, I was accustomed to classifying diseases as those human circumstances where bodily functions are disrupted by virtue of unwanted foreign bacteria or viruses. Because alcoholism seems to stem from genes and response to chemical changes, I would have called it a condition.

Is Parkinson's a diseaser or a condition?

Sweet! It's a psychobabble fight! Can we get an MD and a Chiropractor going in another thread?

:)

I could give you a large list of diseases caused by chemicals/toxins.

In fact some Parkinson's is caused by the chemical MTPT. The shorthand for Parkison's is "PD." Which is "Parkinson Disease."

How did we make the leap of logic to call something a disease = no personal responsibility?

Are STD's not diseases? How about heart disease caused by obesity? Adult onset diabetes?

Are you going to argue that none of those are diseases becasue they are brought on by choices the suffereres made?

How does one define disease?

And is that distinguishable from a condition?

a disease is necessarily a condition. but a condition is not necessarily a disease.

good physical fitness is a condition. it is not disease.

Why do people have no problem categorizing something like OCD a disease, but cannot see that alcoholism, which is a compulsion of a different form, might also be a disease? I think people get hung up because they allow their sense of morality to cloud their ability to look at the condition clinically.

To offer a different perspective, the disease of alcoholism impacts society in a far more egregious manner than does OCD.

My own family, extended that is, has lost millions due to this disease characteristic being prevalent. It led to the destruction of families, and in some instances loss of life.

OCD doesn't do that.

But the impact of a condition has nothing to do with whether it is a disease or not. I brought up OCD, because of its compulsive nature.

People are afraid to classify action based conditions as diseases, because we often believe there are no cures for diseases and henc everything done by a diseased person is excused. That's the fear.

Who are you addressing these questions to? They're good questions, but from my reading of this thread so far I don't see anyone emphatically arguing that these things are not diseases. I see people wondering about the implications of calling alcoholism a disease, and wondering about where calling it a disease leads, practically speaking.

I think it's clear to see, from this thread and the one on Cougarboard, that for whatever reasons this IS a complicated topic, not near as clean-cut or black and white as it would appear. One need only google "alcoholism disease model" to see similar evidence. I don't think the complication comes from deciding on the definitional fit of a medical term per se, I think it comes from the implications that follow and other practical concerns.

Which is why your comment about a psychobabble debate is spot on. At the end of the day, Average Johhny Alcoholic who's seeking help doesn't much care whether it's called a "disease" or not; all he cares about (hopefully) is how to deal with it and fix the problem.

Arriving at calling something a disease, or NOT calling it a disease, is hardly an endpoint or a destination that solves anyone's problems. Hence my argument earlier in the thread that, from a practical standpoint of struggling with alcoholism, it's always more complicated than that.

Anyway, interesting discussion. Back to my drink. ;)

Ding ding.

I think we're just getting caught up in what largely ends up being an inconsequential semantics argument. I suspect many of us agree here on this topic far more than we disagree. But I also think it's interesting that the word 'disease' for better or worse does appear to many to carry connotations about control and responsibility. I think what Archaea's voicing is that when some people think about disease, they think about an invasive pathogen, and what others are saying is that technically that's not all the word 'disease' means.

If that made any sense. :)

that's why if you are going to argue, in polite company, that alcoholism is not a disease, you had better bring your A game.

Because it's a difficult sell. And you've suddenly, whether you want to or not, aligned yourself with the Johnnlingo's who think it's not a disease for perhaps different reasons. And people that are selling books saying the same thing.

Is it possible that what is the disease is some psychic malady like depression, and alcoholism is secondary, a form of self-medication?

You shrinks are the experts but it seems to me that's the root of it and may be the best response to self-righteous FMCoug/Lingo types.

I can say I'm a social drinker and have never felt drawn to overdo it or drink compulsively. (It helps to be a workaholic.) I reach a point of diminishing returns very quickly after a second drink. Usually one is is best. I do think that those who do drink compulsively have a form of disease but what breeds ignorance may be calling drinking the disease rather than identifying some more deep seated illness.

As I'm sure Waters will attest, depression is a real disease.

the self-medication debate is a long one.

did the depression leading to drinking, or did the drinking lead to depression? or did depression lead to drinking which led to worse depression?

Is this person who has been diagnosed with bipolar disorder who uses meth really a bipolar person who uses meth, or just a meth-user who looked bipolar to someone?

Is this schizophrenic who comes in psychotic and cocaine-positive.....is he psychotic because he used the cocaine (and will wear off quickly), or is he psychotic just because (needs hospitalization)?

The analyst types might argue about some deep neurosis that is attempting to be squelched by alcohol. And that the alcohol drinking behavior isn't a disorder unto itself.

I could give numerous more examples. You could probably google "comorbid substance abuse" or "dual diagnosis" and get a lot of information.

Well said.

Is there a school of thought that calls smoking addiction or eating disorders a "disease?" If not why not.

Do "diseases" which are not based upon an invasive pathogen behave similarly to diseases arising from invasive pathogens?

I recognize we classify invasive versus noninvasive pathogens as diseases, but is the path identical for the two branches?

Sure. Technically, if you're playing the diagnosis game, you work to establish that the set of symptoms you've identified are not better accounted for by a different diagnosis. Often, very often, substance abuse/dependence disorders are comorbid; hence an entire field of study dedicated to "dual diagnosis" individuals.

So yeah, absolutely there could be something else more responsible for the problem. Here's the unfortunate reality, at times, for psychologists, psychiatrists, social workers, or anyone else in the field for that matter: The diagnostic system presents a very alluring mode of ambiguity management, and human beings are nothing if not complex. Too often professionals will foreclose on a diagnosis and dive into treating that problem because they see that diagnosis as an endpoint. Clients are often willing participants in this process, too, as sometimes they are happy to collude with the 'expert' in externalizing and abdicating responsibility, or avoiding the deeper, more fundamental issue.

It's likely different with the more severe population that Waters works with, but I generally (not always) work with fairly 'normal' individuals who can maintain at least a semblance of functionality. I can't tell you how many times I've had someone come in, say "yeah, I've got (thus and such) disorder and I need help," only to find after some work and establishing some trust that we're dealing with far more than was originally disclosed. Often these people have diagnosed themselves on some internet site or have heard it from a doctor who saw them for 5 minutes and gave them a 10 question screener. So yeah, I guess what I'm saying is definitely there can be something more to any problem, including alcoholism, that will be key to address in order to facilitate full recovery and healthy living. In fact, I'd use the words 'very often' at least in my work.

To be fair, conversely there are those in my field that are ALWAYS digging deeper, trying to find something that isn't there. It's not surprising to hear of practitioners here and there who have entire caseloads of abuse victims, or of people with multiple personalities--and not because that is their niche, but because that's what they always 'find'.

That was a way longer answer than you were looking for, but I was just talking with someone about this phenomenon so it's on my mind.

Yes, absolutely. In fact, going strictly by the definitions presented earlier in this thread, some have argued that same-sex attraction is also a disease.

Just goes to show you that calling something a disease doesn't necessarily lead anywhere of practical significance.

ADD

There is a diagnosis for "nicotine depedence." So yes, it is coded as a medical disease/condition.

Yes eating disorders are also classified as diseases.

Bulimia nervosa
Anorexia nervosa
Eating disorder Not Otherwise specified.

http://www.psychiatryonline.com/content.aspx?aID=3610

You were answering CatBlue about eating disorders. I hope you are not suggesting that calling eating disorders diseases is unwarranted.

Pulled this from emedicine:

Not to downplay alcoholism, but OCD most certainly destroys families and takes lives. I have seen it happen.

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Haven't I made myself quite clear yet? Whether its warranted or not is hardly my concern. When I have a client in front of me who is eating less than 500 calories a day on top of at least 2 hours of hard exercise, purging daily, who is experiencing chest pains, hair loss, amenorrhea, etc, the last thing on either of our minds is whether or not we should call it a disease. We do... so what? We don't....so what? The call for help doesn't end with a label. "Yeah, so you have a pretty bad disease, go get yourself some fluvoxamine and I'll see you in a month."

I can't think of many more ways to try to make my point.

What was your point again? That telling someone with Anorexia that they do not have a disease is the equivalent to telling that someone that they do?

No greater value is to be placed on the one approach or the other?

I think I'll pass on that philosophy.

Doctors treat disease. Folks with anorexia are not put in the ICU for their non-disease.

If you are not interested in thinking of any human condition as disease, just say so. So we know what we are dealing with.