Is alcoholism a disease or something else?

[MikeSun5]

So the most recent additions to this zombie thread have added exactly zero to the last 11 or so pages. No offense, of course.

As mentioned earlier, this topic seems way too complex to be discussed without first agreeing on a common definition for the word "disease." Once that's done, we must be consistent when using it. Many times in this thread the words "addiction" and "disease" have been convoluted (sometimes intentionally), when they probably shouldn't have been. If they are the same thing, fine. Just be consistent. If addiction is a disease, then shopaholics and overeaters are diseased people. If addiction is not a disease, then alcoholism isn't either, and shouldn't be classified as such.

Consistency is what is lacking, here. While I agree with littleroundman that nothing is ever black and white or "one size fits all," I don't think that some alcoholics have a disease while others simply have mental addiction problems. All alcoholics are addicted to alcohol. Are they all diseased? That's the question here. My opinion is no.

 

[Gandalfs Beard]

So the most recent additions to this zombie thread have added exactly zero to the last 11 or so pages. No offense, of course.

As mentioned earlier, this topic seems way too complex to be discussed without first agreeing on a common definition for the word "disease." Once that's done, we must be consistent when using it. Many times in this thread the words "addiction" and "disease" have been convoluted (sometimes intentionally), when they probably shouldn't have been. If they are the same thing, fine. Just be consistent. If addiction is a disease, then shopaholics and overeaters are diseased people. If addiction is not a disease, then alcoholism isn't either, and shouldn't be classified as such.

Consistency is what is lacking, here. While I agree with littleroundman that nothing is ever black and white or "one size fits all," I don't think that some alcoholics have a disease while others simply have mental addiction problems. All alcoholics are addicted to alcohol. Are they all diseased? That's the question here. My opinion is no.

But that's part of the problem too. Not ALL people labelled alcoholics or addicts may actually be alcoholics or addicts. Habituation and abuse don't necessarily imply addiction. So it's not just the problem of dealing with common usage definitions of disease vs medical definitions of disease.

In my late teens and early 20s I boozed it up and smoked tons of weed because that was what we did after work (or during work ), and on weekends. A lot of people including medical professionals might easily have concluded we were a bunch of "addicts".

After one too many nights of alcohol poisoning and puking my guts out, it was very easy for me to quit boozing it up. And the same went for a lot of my friends as they grew older and maturer.

However, there were a few that became so dependent (despite the hangovers and alcohol poisoning) that it was clear their ability to control (i.e. to choose) their drinking was severely compromised. Under such circumstances the term "Alcoholic" and the term "Disease" seems applicable.

Likewise, many people undergoing severe stress for any number of reasons may be habitually self-medicating to escape the pain of their underlying problems. Solve the underlying problems, and in many cases the habitual usage will naturally diminish.

If it doesn't, then they have become so dependent that again, their ability to "choose not use" has been seriously compromised and has become a neurological problem. And again, under such circumstances the term "Disease" might be quite applicable, because it is no longer a matter of learning to control or modify behaviour patterns. Rather it has become a problem that requires some sort of Medical Intervention.

Then there is a strong Puritanical Social Stigma attached to any use or "abuse" of any drug, particularly in the US (which fuels the Drug Wars). Under these Sociological conditions the "Sin" model and the "Disease" model of drug use and/or "abuse" become conflated Socially and Politically.

Which is likely why the US Medical Community are so quick to label all drug "abuse" as "addiction," and "disease." It has become part of the background assumptions that many people, medical professionals included, operate under.

To conclude, "addiction" is neither as simple as the "choicers" or the "diseasers" would have us believe. Rather, these are both partial truths that are both applicable depending on the circumstances.

This is what LittleRoundMan and I have been attempting to communicate. But some people are so stuck on their own Intellectual Models, or are unable to see past the sociological background assumptions, that they refuse to acknowledge that the "other" side, and/or those in the "middle," might also have some valid points.

So even though I disagree vehemently with UY's categorically claiming that it "all comes back to personal choices" (his Mantra), I DON'T disagree that he may be right about some people. And those people which he may be right about, can be helped to learn new behaviour patterns; nor should such people for whom simply learning new behaviour patterns works necessarily be labelled as having a "Disease."

And indeed, some Shopaholics and some Overeaters, may have neurological disorders that are not treatable simply with behaviour modification techniques, but with some sort of medical intervention. If that is the case, then they can also be said to be "addicts" and to have a "disease"

So that's MY take on it, if you can learn to control or modify your habits or your habits aren't seriously disrupting your life, it's not an "addiction" or a "disease." But if one literally cannot control their "habits" and become utterly dysfunctional, then it is a Neurological Addiction and it is a Disease.

This is probably why so many scientific studies can be cherry-picked to back up one's own confirmation bias.

To me this seems the most reasonable take on the situation, but if people wish to keep intellectually bludgeoning each other to "prove" that their position is the "Correct" Position, fine. I'll simply go back to lurking.

GB

 

[Uncayimmy]

But that's part of the problem too. Not ALL people labelled alcoholics or addicts may actually be alcoholics or addicts. Habituation and abuse don't necessarily imply addiction. So it's not just the problem of dealing with common usage definitions of disease vs medical definitions of disease.

Oh my.

We agree.

Well, sorta. Habituation and abuse do imply addiction, but they don't necessarily mean addiction.

To conclude, "addiction" is neither as simple as the "choicers" or the "diseasers" would have us believe. Rather, these are both partial truths that are both applicable depending on the circumstances.

You switched from the Sin Model to Choicers as if the two are interchangeable. While there is overlap, they are not the same. Personally, I don't really care if somebody wants to abuse alcohol or any other drug. I take Ann Landers' advice and decide if my life is better with that person in it or not. Substance abuse is just one factor. If it doesn't affect me (or my family), then that's fine. I don't look down on people. If they want help, I'll help.

That help starts with the person understanding it's about making choices. By that I don't mean it's simply a matter of sitting at home alone with a bottle of Early Times and choosing not to pour a shot. It's about choosing to change your life so you're not sitting at home alone with a bottle of Early Times in the first place. It's about seeking out the whatever assistance is needed to get to that person's root problem or at least what that person needs to do to succeed. If they need to take Antabuse to condition themselves, so be it. If they need therapy, so be it. If they need detox and a stay at a clinic, so be it. Those are all choices.

So even though I disagree vehemently with UY's categorically claiming that it "all comes back to personal choices" (his Mantra), I DON'T disagree that he may be right about some people. And those people which he may be right about, can be helped to learn new behaviour patterns; nor should such people for whom simply learning new behaviour patterns works necessarily be labelled as having a "Disease."

I would be interested to hear specifically why you disagree with my above explanation about choices. I would also be interested in you presenting an example of someone with an alcohol problem who can resolve it without making any choices at all.

 

[Gandalfs Beard]

Oh my.

We agree.

Well, sorta. Habituation and abuse do imply addiction, but they don't necessarily mean addiction.


You switched from the Sin Model to Choicers as if the two are interchangeable. While there is overlap, they are not the same. Personally, I don't really care if somebody wants to abuse alcohol or any other drug. I take Ann Landers' advice and decide if my life is better with that person in it or not. Substance abuse is just one factor. If it doesn't affect me (or my family), then that's fine. I don't look down on people. If they want help, I'll help.

That help starts with the person understanding it's about making choices. By that I don't mean it's simply a matter of sitting at home alone with a bottle of Early Times and choosing not to pour a shot. It's about choosing to change your life so you're not sitting at home alone with a bottle of Early Times in the first place. It's about seeking out the whatever assistance is needed to get to that person's root problem or at least what that person needs to do to succeed. If they need to take Antabuse to condition themselves, so be it. If they need therapy, so be it. If they need detox and a stay at a clinic, so be it. Those are all choices.


I would be interested to hear specifically why you disagree with my above explanation about choices. I would also be interested in you presenting an example of someone with an alcohol problem who can resolve it without making any choices at all.

In regards to your last paragraph, a person who can't make choices themselves cannot resolve their alcohol problem themselves. A family member would have to make the decision for the alcoholic or addict to get them the medical help necessary. If such a person has no family or friends to help them get treatment, their situation might never be resolved, and they might end up in a Gutter, in Jail, or Dead.

I do agree that the "Sin" model is not equivalent to the "Choicer" model, but that there is some overlap. I didn't intend my statements to imply any more than that.

I am glad to see that by attempting to further clarify my views on the subject, that we have finally been able to reach some common ground though.

GB

 

[littleroundman]

Consistency is what is lacking, here. While I agree with littleroundman that nothing is ever black and white or "one size fits all," I don't think that some alcoholics have a disease while others simply have mental addiction problems. All alcoholics are addicted to alcohol. Are they all diseased? That's the question here. My opinion is no.

The problem here, as I see it, is that there are countless differing definitions available of what constitutes an "alcoholic" each backed up by research and "facts"

HOWEVER, many of those definitions are totally at odds with each other, and NONE of the authors of the studies claims that their definition applies to ALL of the millions of people to whom society applies the description term"alcoholic"

The same criteria, when applied to what "causes" "alcoholism" produces a similar outcome.

Ditto with how to "cure" "alcoholism"

It is simply impossible to apply the same definition, cause, effect, treatment or even specific description to a group of HUMAN BEINGS, (as in: people, not mass produced machines) of such numbers, cultures and/or geographic locations.

It matters not one whit what I have seen, experienced, read about, believe or been taught.

Unless I can prove, beyond a shadow of a doubt that each and every one of those millions, if not billions, of humans fits within a single definition of alcoholism and the condition and/or cause is EXACTLY the same in each and every one of them a single treatment is guaranteed to work for each and every one, then I can possibly answer the OP question with a singular answer. And, I would argue, nor can anyone else.

Well, unless, of course, I belonged to a religion which says everything "bad" is the work of the devil.

 

[Dancing David]

But that's part of the problem too. Not ALL people labelled alcoholics or addicts may actually be alcoholics or addicts. Habituation and abuse don't necessarily imply addiction. So it's not just the problem of dealing with common usage definitions of disease vs medical definitions of disease.

GB

As I stated it is continued use despite the severe negative consequence that is the hallmark of addiction. Higher tolerance is not a nessecary condition. It is a pattern of habitual use that intereres with life functioning.

Now part of the issue is that it can be hard to assign a metric to these behaviors
ICD
http://www.who.int/substance_abuse/terminology/definition1/en/

Dependence syndrome
Definition
The Tenth Revision of the International Classification of Diseases and Health Problems (ICD-10) defines the dependence syndrome as being a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take the psychoactive drugs (which may or not have been medically prescribed), alcohol, or tobacco.
...

In unqualified form, dependence refers to both physical and psychological elements. Psychological or psychic dependence refers to the experience of impaired control over drinking or drug use while physiological or physical dependence refers to tolerance and withdrawal symptoms. In biologically-oriented discussion, dependence is often used to refer only to physical dependence.

Dependence or physical dependence is also used in the psychopharmacological context in a still narrower sense, referring solely to the development of withdrawal symptoms on cessation of drug use. In this restricted sense, cross-dependence is seen as complementary to cross-tolerance, with both referring only to physical symptomatology (neuroadaptation).

....
ICD-10 Diagnostic guidelines
A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:

-A strong desire or sense of compulsion to take the substance;
Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
-A physiological withdrawal state when substance use has ceased or have been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
-Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
-Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
-Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

 

[Dancing David]

The problem here, as I see it, is that there are countless differing definitions available of what constitutes an "alcoholic" each backed up by research and "facts"

Hmmm, okay, I am not sure what you are saying, the ICD and SDSM criteria are remarkably similar, now causitive factors are very wide.

 

[littleroundman]

Hmmm, okay, I am not sure what you are saying, the ICD and SDSM criteria are remarkably similar, now causitive factors are very wide.

And, the World Health Organization says, in its' own words:

alcoholism (F10.2) A term of long-standing use and variable meaning, generally taken to refer to chronic continual drinking or periodic consumption of alcohol which is characterized by impaired control over drinking, frequent episodes of intoxication, and preoccupation with alcohol and the use of alcohol despite adverse consequences. The term alcoholism was originally coined in 1849 by Magnus Huss. Untill the 1940s it referred primarily to the physical consequences of long-term heavy drinking (beta alcoholism in Jellinek's typology). A narrower concept is of alcoholism as a disease (see alcoholism, disease concept of) marked by loss of control over drinking, caused by a pre-existing biological abnormality, and having a predictable progressive course. Later, the term was used by Jellinek and others to denote the consumption of alcohol leading to any type of harm (physical, psychological, or social; individual or societal). Jellinek subdivided alcoholism thus defined into a series of "species" designated by Greek letters (see Jellinek's typology). The inexactness of the term led a 1979 WHO Expert Committee* to disfavour it, preferring the narrower formulation of alcohol dependence syndrome as one among a wide range of alcohol-related problems. Alcoholism is not included as a diagnostic entity in ICD-IO (see dependence syndrome). Despite its ambiguous meaning, alcoholism is still widely employed as a diagnostic and descriptive term. For instance, in 1990 the American Society of Addiction Medicine defined 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 continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial." Other formulations have split alcoholism into various types, some regarded as diseases and some not (see Jellinek's typology). Distinctions are made between essential alcoholism and reactive alcoholism, where "essential" indicates that alcoholism is not secondary to or precipitated by some other condition; between primary and secondary alcoholism, to indicate the order of onset in cases of dual diagnosis; and between Type I and Type II alcoholism, the latter having a male-linked, strongly genetic component. In older usage, dipsomania (episodic drinking) and alcohol addiction referred to loss-of-control drinking: inebriety also had a broader reference to habitual intoxication and its harmful effects.

http://www.who.int/substance_abuse/terminology/who_lexicon/en/

 

[Uncayimmy]

In regards to your last paragraph, a person who can't make choices themselves cannot resolve their alcohol problem themselves. A family member would have to make the decision for the alcoholic or addict to get them the medical help necessary. If such a person has no family or friends to help them get treatment, their situation might never be resolved, and they might end up in a Gutter, in Jail, or Dead.

Is it possible for a family member to force an alcoholic into treatment? Obviously, if the person is an immediate danger to himself or others, you can get an emergency evaluation type thing done. Beyond that, I don't think it's possible (at least in the USA). Once the person gets into treatment, it's still a matter of choice to follow the treatment. People get kicked out of treatment centers all the time for not following the rules.

The choice model never breaks down, even if we use the legal system to enforce treatment. The person still has to make choices to follow the treatment and continue with new behaviors after "successful" treatment. If someone chooses to start drinking again, the "disease" is back.

The disease model always breaks down somewhere. If someone has a traditional disease, we could treat them surreptitiously (say slipping medicine into their food) and cure the body. We could perform a surgery once to say remove a tumor. We could even force medications or surgeries on a person to cure the body.

If LittleRoundMan wants to make the "it's this and something else" argument, then the "this" should be a behavioral problem, not disease.

 

[MikeSun5]

The choice model never breaks down, even if we use the legal system to enforce treatment. The person still has to make choices to follow the treatment and continue with new behaviors after "successful" treatment. If someone chooses to start drinking again, the "disease" is back.

The disease model always breaks down somewhere. If someone has a traditional disease, we could treat them surreptitiously (say slipping medicine into their food) and cure the body. We could perform a surgery once to say remove a tumor. We could even force medications or surgeries on a person to cure the body.

Well put. This is pretty much how I've been viewing this issue. UncaYimmy does a very important thing here by including the word "traditional." I think one of the biggest reasons this is so controversial is because most people define the word "disease" traditionally: a disease is some sort of contagious malady. Then there are those who point straight to definitions of "disease" provided by the AMA and such to dispel that old wive's tale of a definition. The disconnect is the accepted definition of the word. I would argue on behalf of the people who put alcholism on the shelf with cigarette and gambling addictions, and not on the shelf with syphillis and meningitis.

Since alcoholism has been labeled a disease by (almost exclusively North American) health organizations and medical journals, funding for alcoholism-related organizations has increased exponentially. I'm not going to hunt for it, but someone here provided a link that showed organizations dealing with alcoholism didn't want to be lumped together with organizations simply dealing with addiction because the alcoholism companies would take a substantial cut in funding. If alcoholism got downgraded from disease to addiction, many organizations would suffer financially. I know, I know. Who would let something silly like money get in the way of helping people? Crazy.

 

[AlBell]

Yawn. Is Type II diabetes a disease? Or just another character defect?

 

[littleroundman]

Yawn. Is Type II diabetes a disease? Or just another character defect?

Or, in fact, is "diabetes" just "diabetes" or, is there more than one version of the commonly used word "diabetes" ????

 

[AlBell]

Either way, disease ... or character defect?

 

[Uncayimmy]

Either way, disease ... or character defect?

I'm just letting you know that your false dichotomy laced with emotional language is not worthy of discussion from me.

 

[littleroundman]

Either way, disease ... or character defect?

Given the fact there are SOME forms of type II diabetes which CAN be effected and even, in some cases, eliminated, by lifestyle changes then it can be argued that those particular forms of type II diabetes could be considered to be the result of defective lifestyle choices, which could, at a stretch, make those particular forms of type II diabetes a "character defect"

There are other forms within the description "type II diabetes" which are NOT effected by lifestyle choices i.e. no amount of diet control, exercise or weight loss will effect the condition at all.

And that's without discussing "type I" diabetes or "gestational" diabetes.

The word "diabetes" like the terms "alcoholism" or "cancer" or "heart attack" may be convenient generalizations to use in forum debate or general conversation

However, when discussing causes and treatment options, those involved simply cannot generalize.

Which is why the reply to the OP question remains "both"

 

[AlBell]

I'm just letting you know that your false dichotomy laced with emotional language is not worthy of discussion from me.

Thank FSM for small favors.

 

[Gandalfs Beard]

Given the fact there are SOME forms of type II diabetes which CAN be effected and even, in some cases, eliminated, by lifestyle changes then it can be argued that those particular forms of type II diabetes could be considered to be the result of defective lifestyle choices, which could, at a stretch, make those particular forms of type II diabetes a "character defect"

There are other forms within the description "type II diabetes" which are NOT effected by lifestyle choices i.e. no amount of diet control, exercise or weight loss will effect the condition at all.

And that's without discussing "type I" diabetes or "gestational" diabetes.

The word "diabetes" like the terms "alcoholism" or "cancer" or "heart attack" may be convenient generalizations to use in forum debate or general conversation

However, when discussing causes and treatment options, those involved simply cannot generalize.

Which is why the reply to the OP question remains "both"

Exactly.

I know I'm on a bizarre thread when I partly agree with both UncaYimmy and AlBell.

GB

 

[Dancing David]

And, the World Health Organization says, in its' own words:



http://www.who.int/substance_abuse/terminology/who_lexicon/en/

I don't recall posting anything other than the dependence criteria, type I and type II are valid categories, due to the probanding in type II and you present quotes from 1990, seriously?

If you read my prior post you would not that I have stated over and over that alcoholism or alcohol dependence is multivariate, so I don't know what you think you are really adding to the conversation.

How prevalent is Jellinek's typology in the treatment community, it is really relevant?

 

[Dancing David]

Or, in fact, is "diabetes" just "diabetes" or, is there more than one version of the commonly used word "diabetes" ????

Type II diabetes is essentially very different from type I diabetes, it starts as a lack of response to insulin, as opposed to the lack of production, the end effects are the same however. Type II is heavily influenced by the behaviors of the individual, high triglycerides, borderline blood sugars and obesity are all related to the onset of type II.

So in this situation, the multiple biological predispositions and a behavioral component, however I would not classify type II diabetes as a behavioral disorder. I am modifying my behaviors as my maternal grandfather and my mother bother had and have type II diabetes, I take a statin, I exercise regularly, I try not to consume too many carbos and I avoid sugar and alcohol.

The biological predisposition exists however, I am starting to express it, I have had high triglycerides and the borderline blood sugars (even before I became obese).

So there are both components, I have a very strong biological predisposition and need to change my life style. Now I also have alcohol dependence on both sides of my family but that was never my substance of choice.

 

[Dancing David]

Given the fact there are SOME forms of type II diabetes which CAN be effected and even, in some cases, eliminated, by lifestyle changes then it can be argued that those particular forms of type II diabetes could be considered to be the result of defective lifestyle choices, which could, at a stretch, make those particular forms of type II diabetes a "character defect"

I found in my fifteen years as a social worker that the moral model is unproductive, no character defects, just healthy and unhealthy choices.

Character is such a vague ambiguous thing that I tended to avoid it, it is specific behaviors that need to be changed, the character is what it is.