Is alcoholism a disease or something else?

[Dancing David]

I am in no way arguing against alcoholism being largely due to a genetic predisposition.

At this time it appears there is a segment of the population that is more vulnerable to the alcohol dependence. In my case the genes may have passed me by, for that vulnerability. One great uncle, one grandfather, one uncle. not me.

I agree, it is caused in large part by genes and I have little problem with those who want to use "disease" instead of "genetic predisposition". If on the other hand by disease they mean "I can't do anything about it", then I disagree.

Agreed, disease as in 'a focus of treatment', not as in helpless.

Perhaps the addictive personality that leads to alcohol,

Not so much personality as there are often other conditions, social and physical that people are trying to self medicate. People with high anxiety levels, depression, etc... There was some study almost 15 years ago about low levels of endorphins.

or cocaine addiction or sugar addiction is a disease.

Now stimulants have a very high addiction profile, but then I also remember the famous cocaine is 'psychological addictive' issue.

It seems there has been little attempt here to address my assertion that alcoholism is probably a form of self-medication for anxiety and/or depression with these anxiety issues perhaps being closely associated with the addictive personality(or being the same thing).

I agree, it is often an unhealthy coping mechanism, some people also have the biological predisposition, then also along side those with mental illnesses, trauma, stress and social/cultural conflicts and struggles. However there are seem to be those who have no mental illness at all and even despite the lack of comorbidity become alcohol dependant.

 

[Dancing David]

Because self medication via alcohol is undoubtedly true in SOME cases.

As I have previously pointed out, given that, in the US alone the numbers of people with alcohol related problems numbers upward of 10 MILLION, the chances of there being a singular definition, cause, predisposition or, indeed, outcome are negligible.

Anyone even loosely connected with the study/ies and treatment/s of alcohol and/or dependence/addiction and/or related problems could probably furnish case studies and personal observations to prove or disprove any one of the theories and anecdotal evidence presented here.

The fact we are dealing with extremely large numbers, in fact, multiple millions of "people" not robots indicates the chances of any "one" definition being "right" are next to none.

Self medication ? Undoubtedly, for SOME

Genetic predisposition ??? Yep again, for SOME.

In 10 MILLION PLUS people there is the potential for 10 MILLION plus explanations and causes.

Single "cause" or even single "cure" ???? Highly improbable.

True.

 

[Dancing David]

I have a hard time believing it's a "disease" (depending on what you mean by that) when it can easily explained as a sort of chronic lack of self-discipline.

Protestant moralizing.

Not that this really changes anything. Whatever your want to call it, alcoholics still are going to have a hard time stopping themselves drinking, or limiting it to a small amount.

Limiting it to a small amount is a dangerous choice, avoidance is the easier path. Although I was friend of a WWII vet, drank hard for 50 years (and met all the criteria for dependence, especially the negative consequences), gave it up, was sober for two years and even tested himself. Had a six pack, drank one beer and then left the other five, for three more years, until his death.

In his case it seems that the period of abstinence was enough to break the cycle, but then he also chose to leave the other five.

 

[Halfcentaur]

What do you call it when continued abuse of a substance causes physiological changes in the brain? New neural pathways are created from constant abuse of some substances. It becomes more than an issue of simple self control at that point. Just because it started out as a lapse in self control over not pushing the "happy button" doesn't mean you can't look at it as an eventual "disease'. But there are many definitions of disease.

I do feel AA creates an atmosphere of excuses. I despise it. It gives you a reason to keep relapsing on a silver platter.

 

[Dinwar]

What it tells us is that there is the possibility for "alcoholism" to be a disease AND not a disease, genetic AND not genetic, behavioural AND not behavioural.

The same thing could be said about any affliction affecting more than two people. The data you've presented allow for such a possibility, but in no way argue for it.

What data do you have supporting the idea that it's multiple disorders? And what is your definition of disease?

Limiting it to a small amount is a dangerous choice, avoidance is the easier path.

"Easier" and "harder" are irrelevant here--a bacterial infection doesn't stop being a disease because a shot of penicillin will cure it, and AIDS doesn't stop being a disease because it's incurable.

Agreed, disease as in 'a focus of treatment', not as in helpless.

That's not a very good definition, because it amounts to "a disease is whatever I decide to treat." My left eye barely works; I was prescribed 1 hour of video games a night, using only my left eye. Does that make it a disease? Alternatively, my father has knee issues that he refuses to treat. Does that make it NOT a disease?

What do you call it when continued abuse of a substance causes physiological changes in the brain?

Acclimation.

 

[littleroundman]

The same thing could be said about any affliction affecting more than two people. The data you've presented allow for such a possibility, but in no way argue for it.

What data do you have supporting the idea that it's multiple disorders? And what is your definition of disease?

I will provide the data:

right after someone provides a universally accepted definition of what constitutes "alcoholism" a universally accepted "treatment" and/or a universally accepted "cure"

In the absence of agreement/s, there are only "possibilities" a fact which is only magnified by virtue of the numbers of people concerned.

 

[FattyCatty]

By using the singular word "diabetes" you are making the same error as people who use the singular term "alcoholism"

"Diabetes" is merely a convenient grouping of several related diseases under a single single name "diabetes mellitus", each condition having differing causes, effects, treatments and attached danger/s.

Rather than filling the thread with an explanation, those so interested might like to acquaint themselves with the differences between "insulin dependent/type1/juvenile onset" diabetes and "type 2/adult onset/ diabetes and "gestational" diabetes and "pre diabetes" and "metabolic syndrome" here: http://www.emedicinehealth.com/diabetes/article_em.htm

My point being, while the lay population may find it more convenient to refer to "diabetes" and "alcoholism" and, indeed the "common cold" in singular terms, those in the health and caring professions certainly do not

According to your link, diabetes consists of Type I, Type II, and gestational; "pre-diabetes" is related to but is not diabetes; "metabolic syndrome" is not diabetes, it includes insulin resistence with additional conditions. The treatment of diabetes, whether with insulin, medicine, or lifestyle changes, is for the purpose of regulating blood glucose levels. Is it not true, however, that for all these forms of diabetes there is no cure; that management of the disease (i.e., regulation of blood glucose) is the goal? Which was the point of using diabetes as a comparison to alcoholism.

<snip>I'm curious as to why you cut the rest of the definition. That said, it's a good starting point.

Unfortunatley, the definition appears circular.
<snip>
Which means your definitions translates as "A disposition to undergo organic processes occurring as a consequence of a disease, which exist in an organisms because of one or more ailments that affect the function of the mind or body of the organism." Which means that a disease is that which has the symptoms of a disease. Perhaps there's a nuance or ten I'm not picking up, but that definition would never fly in any other scientific field, so I doubt that it would stand (as it is presented in this post) in medicine.
<snip>

The terms you looked up were defined in the quote. The paper followed the principles of the Open Biological and Biomedical Ontologies (OBO) Foundry. Using the definitions the authors gave, there is a clear progression to disease. The authors' approach was to treat diseases as dispositions rooted in physical disorders in the organisim and realized in pathological processes. The parts I "snipped" were examples, as you would have seen if you had used the link

Here's one definition, from Toward an Ontological Treatment of Disease and Diagnosis (Scheuermann, Ceusters, and Smith) http://ontology.buffalo.edu/medo/Disease_and_Diagnosis.pdf:

disorder =def. -- A causally relatively isolated combination of physical components that is (a) clinically abnormal and (b) maximal, in the sense that it is not part of some larger such combination. <snip> Such disorders are the physical basis of disease. A disease comes into existence because some physical component becomes malformed. In some cases the disorder is a congenital malformation. In other cases it involves a virus or toxin coming in from the outside, or it arises because the absence of a normal bodily component leads to abnormal functioning.

Pathological Process =def. -- A bodily process that is a manifestation of a disorder. <snip>

Disease =def. -- A disposition (i) to undergo pathological processes that (ii) exists in an organism because of one or more disorders in that organism. <snip>

I will provide the data:

right after someone provides a universally accepted definition of what constitutes "alcoholism" a universally accepted "treatment" and/or a universally accepted "cure"

In the absence of agreement/s, there are only "possibilities" a fact which is only magnified by virtue of the numbers of people concerned.

From The Definition of Alcoholism (Morse and Flavin) jama.ama-assn.org/cgi/content/abstract/268/8/1012 (unfortunately, it's pay-to-view the full document):

Abstract

To establish a more precise use of the term alcoholism, a 23-member multidisciplinary committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine conducted a 2-year study of the definition of alcoholism in the light of current concepts. The goals of the committee were to create by consensus a revised definition that is (1) scientifically valid, (2) clinically useful, and (3) understandable by the general public. Therefore, the committee agreed to define alcoholism as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.

(JAMA. 1992;268:1012-1014)

 

[lionking]

Okay, let's assume alcoholism is a disease. I have stopped drinking without any assistance at all. Is this not miraculous? How many other diseases are spontaneously cured in this way?

 

[zerospeaks]

Okay, let's assume alcoholism is a disease. I have stopped drinking without any assistance at all. Is this not miraculous? How many other diseases are spontaneously cured in this way?

TONS. The placebo effect is very high.
It's amazing how your mind can effect everything.
Homeopathic medicine counts on it.

 

[jiggeryqua]

Okay, let's assume alcoholism is a disease. I have stopped drinking without any assistance at all. Is this not miraculous? How many other diseases are spontaneously cured in this way?

It's not cured. You still have it. The abeyance of an individual symptom is not a cure.

 

[godofpie]

what a buzzkill, godofpie

Sorry. Didn't mean to bring the room down.

 

[Gandalfs Beard]

It's not cured. You still have it. The abeyance of an individual symptom is not a cure.

It depends if the Alcoholism is a disorder in itself (which it is in some cases), or if the "Alcoholism" is actually a "symptom" of self-medicating for another problem altogether.

I don't understand why people with so many otherwise different perspectives on "Addiction" seem to concur when it comes to lumping all forms of "Addiction" together into one disorder, or labeling some forms as a "Disorder" at all.

Self-Medicating seems like a perfectly natural response to Pain, physical or emotional.

GB

 

[Gandalfs Beard]

TONS. The placebo effect is very high.
It's amazing how your mind can effect everything.
Homeopathic medicine counts on it.

So do over-the-counter pain medications.

GB

 

[godofpie]

None of that is a valid argument for " Alcoholism is a disease. " It simply shows that alcohol, when consumed in unhealthful amounts, causes damage to the body. The same for inhaling toxic vapors.

I think that would depend on the addictive properties of the fumes. Nobody would intentionally inhale say hydrochloric acid because it would kill them and it wouldn't feel good. Inhaling cocaine vapors on the other hand....
And I think that Steve's, like many alcoholics, inability to admit? to see? to come to grips with? I don't know how to put it really but his refusal to admit that alcohol is causing his organs to fail plays a big part in calling it a disease. I'd be OK with the word disorder for the condition of addiction instead of disease, but the disease concept is so hard wired in my brain, I am afraid that if I look at it any other way I might convince myself that I can drink like a normal person.

 

[lionking]

It's not cured. You still have it. The abeyance of an individual symptom is not a cure.

That is nothing but an unsupported assertion. If I never drink again I'm an alcoholic? Rubbish.

You may just as well say aging is a disease.

 

[AlBell]

Okay, let's assume alcoholism is a disease. I have stopped drinking without any assistance at all. Is this not miraculous? How many other diseases are spontaneously cured in this way?

Do you classify yourself as an alcoholic? If so, why?

 

[lionking]

Do you classify yourself as an alcoholic? If so, why?

How do you define an alcoholic?

ETA I was dependent on alcohol. I'm not now because I'm not drinking and am not missing it. I was once dependent on my mother. I'm not now.

Know what the "once an alcoholic, always an alcoholic" advocates sound like?

Catholics.

If you were raised a Catholic, been baptized and confirmed, then dogma holds that you are always a Catholic, you have merely "lapsed". How many ex-Catholic atheists here would like to be told they are "really" still Catholic?

 

[Halfcentaur]

I would only classify it as a disease in the case of opiates and other similar substance which effectively rewire your brain after sustained periods of habitual and daily use. Until the user can abstain long enough to go back to producing their own sustainable levels of endorphins, then it becomes an issue of personality and personality disorder. I think it's wrong to look at it like addiction is a specific disease. I think rather that there is a genetic propensity for a lack of self control and will power in resisting habitual stimulation. This addictive personality transcends into many different activities. It is not isolated to substance abuse. It just so happens that some substances cause trace physiological side effects in the user as well, which is a double whammy for those prone to addictive behavior. Too many people in AA play word games I think.

 

[AlBell]

Do you classify yourself as an alcoholic? If so, why?

How do you define an alcoholic?

In my own case, the shambles of my life and the lives of those around me started to become more clearly related to my behaviors when drinking compared to my behaviors when not drinking.

For you, your definition is what counts.

 

[lionking]

I'm sorry, but I still think classifying alcoholism as a disease (even if there is a technical reason for doing so), provides a cast-iron excuse for the behavior of at least some alcoholics. "It's not my fault. It's a disease. Hell it's even genetic". How can I say this? Because I've used exactly this excuse more than once.