Is alcoholism a disease or something else?

[Gandalfs Beard]

You don't seem to understand what research is.

Another insulting comment touting your expertise.

We are specifically talking about the NIH claiming that the craving for alcohol can be stronger than the need for water and food. In order for somebody to say that, there must be some research behind it. Point me to that research, meaning the studies that made this conclusion. Do not point me to somebody simply saying that such research exists. If you cannot see the difference, then please do not waste any more of my time.

This study regarding Stress, Alcohol and GABA receptors indicates that researchers were able to determine that some alcohol dependent persons had alcohol craving severity cues that exceeded water cues by at least 50%:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805701/

This human lab model involves initially classifying non treatment-seeking paid volunteers with alcohol dependence as cue reactive if their ratings of craving severity to in vivo alcohol cues exceed that to water cues by at least 50%.

In case some people are wondering what the term "cues" refers to, it relates to laboratory methods of determining the varying strength of "cravings" :

http://pubs.niaaa.nih.gov/publications/arh23-3/179-186.pdf


In laboratory settings, psychophysiological and behavioral responses are often measured within “cue reactivity” studies, which assume that the subject’s responses to alcohol-related stimuli can reflect craving (for more information
on cue-reactivity studies, see the article
in this issue by Litt and Cooney, pp.
174–178). Cues that have been used in
studies of alcohol craving include the
sight, smell, and taste of alcohol; pictures
or videos of alcohol or alcohol-related
scenarios, such as a barroom; the study
participant’s belief that he or she will
consume alcohol; and mental imagery
of alcohol-related situations. Negative
mood manipulations, which typically
involve the participant imagining being
in an unpleasant situation or being presented with a stressor that will invoke
such a mood, also have been used as a
cue for alcohol craving in some studies.
Unfortunately, these studies have rarely
demonstrated close relationships
among behavioral, psychophysiological,
and subjective measures of craving.
Alcoholics’ responses to craving-induction
procedures appear to vary considerably
as a result of numerous individual differences and situational factors. Nonetheless, cue-reactivity measures have provided valuable information about the correlates of craving. Significantly, some studies have shown that autonomic reactions to alcohol cue presentations, such as changes in skin conductance,3
can predict later relapse to drinking
(e.g., Drummond and Glautier 1994).

GB

 

[Uncayimmy]

Another insulting comment touting your expertise.

It's a statement of fact. I asked for research, and she wasted my time telling me that my own source said such research exists without citing the research!

This study regarding Stress, Alcohol and GABA receptors indicates that researchers were able to determine that some alcohol dependent persons had alcohol craving severity cues that exceeded water cues by at least 50%:

First it would help if next time you linked to the actual study rather than somebody else's interpretation of the study. Thanks!

Second, that study does not support the NIH statement, "The craving that an alcoholic feels for alcohol can be as strong as the need for food or water." It says that if you take a bunch of alcohol dependent people and present them with cues for water or booze, they will react more strongly to booze. I mean, seriously, you needed a study to tell you that? I'm pretty sure you'd get the same reactions for comparing water to soda or orange juice. Or a Twinkie versus cooked squash. It doesn't mean the craving is greater than the need for food or water.

<shakes heade> I hope that's not the study upon which the NIH statement relies, but it wouldn't surprise me.

 

[Baylor]

It just so happens I agree with you insofar as those who DO have the ability to control their impulses can learn to modify their behaviour patterns.

I also happen to agree with you that applying the term "Disease" to those who have a Behavioural problem is a mis-application of the term.


But the fact is you AREN'T a Medical Professional, and you're NOT PSYCHIC, therefore you have no grounds on which to claim "It's ALWAYS a choice."

And given the Neuro-Biological Dysfunctions that can (and DO) limit, or inhibit IMPULSE CONTROL in some people, for all intents and purposes, the definition of "Disease" that includes Physiological Malfunctions IS applicable.

I happen to agree with you here. But it's the neurobiological dysfunction that's the disease, not alcoholism. "Alcoholism" is merely an abstraction to describe a habitual behavior pattern.

 

[xjx388]

You haven't proven that by any stretch of the imagination.

You asked for an illustrative case. One was provided. You asked for research. It was provided. What now?

Actually, it's not really appropriate at all. Either my arguments stand on their own or they do not.

Ok then. Your arguments do not stand on their own. They are simply your own opinion and have no basis in any research, expert consensus or any other source outside your own head.

No. You're supposed to prove me wrong. Show me the evidence indicating that a desire for alcohol is as strong as that for food and water. I'll accept that.

This evidence has been presented. Something tells me we shouldn't hold your breath for any concessions from you.

Respond to the post in question based on its merits. Times 5.

Done it. Times 5.

Your arguments are following a familiar pattern. You are unable to refute or even address my arguments on their merits, so you respond with an argument from authority. I respond by showing you that there is not a consensus. You then either impeach the authority or dismiss their arguments with a hand wave while claiming that I am now somehow arguing from an authority (and point out gleefully that I do not have any authority).

I've refuted your arguments on their merits with research and demonstrable consensus in the Medical community. You tell me they are wrong and counter with two editorials and one irrelevant study. The weight of the evidence is strongly against you here.

Disorders are not diseases? But NIH says they are different. Are you saying NIH is wrong now? Very convenient. FYI, MPD is not diagnosed by behavior. Autism, a disorder, is diagnoses mostly by lack of certain characteristics. Since neither is a disease...

Oh great, now you are telling us how things are diagnosed. Geez . . .

I'm saying that disorders and syndromes are diseases and vice versa. They are synonyms. In some rare (almost arbitrary) cases (like in Cushing's Syndrome/Disease), the words denote particular things. Cushing's Syndrome refers to a general disorder (hypercorticism) while the word Disease refers to a specific presentation of the Syndrome (Cushing's Disease = Cushing's Syndrome caused by a tumor). But Cushing's Syndrome and Cushing's Disease are both Disorders. The only reason a different term is used is for clinical utility, not because one is "not a disease."

UY, I really don't see a point to continuing this further unless you have something new to add (a study, expert consensus, etc.) that you haven't already rehashed to death. Your opinion will not cut it anymore.

 

[Gandalfs Beard]

I happen to agree with you here. But it's the neurobiological dysfunction that's the disease, not alcoholism. "Alcoholism" is merely an abstraction to describe a habitual behavior pattern.

That's exactly my point.

The thing is UncaYimmy seems to think that habitual behaviour patterns related to "alcoholism" is all about "Choice," not neuro-biological dysfunction (or any number of other factors that might limit or inhibit Impulse Control. But he has yet to present any evidence that actually backs up his confirmation bias.

GB

 

[littleroundman]

I happen to agree with you here. But it's the neurobiological dysfunction that's the disease, not alcoholism. "Alcoholism" is merely an abstraction to describe a habitual behavior pattern.

Well said.

 

[Gandalfs Beard]

It's a statement of fact. I asked for research, and she wasted my time telling me that my own source said such research exists without citing the research!

Great, so you won't mind if I tell you that you don't understand what the research says!

First it would help if next time you linked to the actual study rather than somebody else's interpretation of the study. Thanks!

Second, that study does not support the NIH statement, "The craving that an alcoholic feels for alcohol can be as strong as the need for food or water."

Did you even READ what you just wrote?

It says that if you take a bunch of alcohol dependent people and present them with cues for water or booze, they will react more strongly to booze. I mean, seriously, you needed a study to tell you that? I'm pretty sure you'd get the same reactions for comparing water to soda or orange juice. Or a Twinkie versus cooked squash. It doesn't mean the craving is greater than the need for food or water.

The only distinction I see between the highlighted statements is that the second highlighted statement says that the cravings of Alcoholics (i.e. alcohol dependent people) will be 50% STRONGER for alcohol than for water.

Then you bluster that "of course that is the expected reaction," after previously telling us that you don't even believe the NIH statement. There's no emoticon strong enough to indicate how ridiculous I think your cognitive dissonance is.

<shakes heade> I hope that's not the study upon which the NIH statement relies, but it wouldn't surprise me.

So, an article published at the same NIH site about an NIH study on the same site misrepresented the study and NIH didn't catch it?

GB

 

[Gandalfs Beard]

I really don't know what you're ranting about. OCD is not a disease - it's a disorder. To the best of my knowledge no disease causes OCD, though there is an unproven hypothesis about rapid onset of OCD in children as part of an immune response.


You say it's a disease and many something elses. I say it's a behavioral disorder. Nobody in this thread has argued that there are not multiple factors affecting the disorder. You can continue to pretend as much. It's what we in America call a straw man.

Is your distinction between "Disease" and "Disorder" based on the narrow definition of "Disease" as caused by Pathogens?

If OCD is Neurologically (Physiologically) based, then what purpose is served by not acknowledging the broader definition of "Disease" as it relates to any physiological malfunctions?

As to your contention that OCD is a Behavioural Disorder rather than a Physiological Disorder, do you have Proof? Or is this just an assertion based on traditional psychological assumptions, and your confirmation bias misreadings of current research?

http://www.ncbi.nlm.nih.gov/pubmed/20833001

Regional gray and white matter volume abnormalities in obsessive-compulsive disorder: a voxel-based morphometry study.

Togao O, Yoshiura T, Nakao T, Nabeyama M, Sanematsu H, Nakagawa A, Noguchi T, Hiwatashi A, Yamashita K, Nagao E, Kanba S, Honda H.

Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan. toggy321@yahoo.co.jp

Abstract

Previous studies have demonstrated both functional and structural abnormalities in the frontal-striatal-thalamic circuits in obsessive-compulsive disorder (OCD). The purpose of this study was to assess volume abnormalities not only of gray matter (GM), but also of white matter (WM) in patients with OCD using voxel-based morphometry (VBM). Subjects consisted of 23 patients with OCD and 26 normal control subjects. All patients were drug-free for at least 2 weeks before the study. Three-dimensional T1-weighed MR images were obtained in all subjects. Optimized voxel-based morphometry was performed to detect structural difference between the two groups. The patients with OCD demonstrated a significant reduction of GM volume in the bilateral medial prefrontal cortex, right premotor area, right orbitofrontal cortex (OFC), right dorsolateral prefrontal cortex, and bilateral temporal and occipital regions. The OCD patients also showed a significant WM volume increase in the right anterior limb of the internal capsule, right orbitofrontal region, and a significant WM volume reduction in the left anterior cingulate gyrus. Our findings are consistent with previous studies implicating dysfunction of the frontal cortex including the OFC. The results suggested that WM volume abnormalities in the orbitofrontal region, anterior limb of the internal capsule, and anterior cingulate gyrus would imply abnormalities in the pathways of frontal-striatal circuits.

Is Tourette Syndrome a Behavioural Disorder or a Physiological Disorder? NIMH studies show these disorders may be related.

http://www.ncbi.nlm.nih.gov/pubmed/...roller.PPMCArticlePage.PPMCPubmedRA&linkpos=1

[The neurobiological bases of obsessive-compulsive disorder and Tourette syndrome].
[Article in Portuguese]

Mercadante MT, Rosario-Campos MC, Quarantini LC, Sato FP.

Programa de Pós-graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie. mt.mercadante@uol.com.br
Abstract
OBJECTIVE: To describe and discuss evidence-based articles on the neurobiology of obsessive-compulsive disorder and Tourette syndrome.

SOURCES OF DATA: A review of the most relevant papers on the phenomenology, neuroanatomy, neuroimaging, genetic and immunological aspects of these two disorders was performed.

SUMMARY OF THE FINDINGS: Ritualistic behaviors and repetitive thoughts have been extensively studied in the last years. The definitions of obsessive-compulsive disorder and Tourette syndrome emphasize the existence of a continuum of symptoms, with high prevalence in the general population. Neurobiological findings have implicated genetic and immunological factors in the etiology of these two disorders.

CONCLUSIONS: Advances in neuroscience triggered genetic and immunological research studies, allowing new perspectives on the treatment of obsessive-compulsive disorder and Tourette syndrome patients.

So UncaYimmy, more data comes in every day that reveals that "Disorders" previously believed to be Psychological (Behavioural) Disorders are more than likely Physiologically based.

What are you going to do with yourself when you can't tell people that it's their own fault they are drunks or fat anymore?

GB

 

[jhunter1163]

Some posters in this thread are getting perilously close to the incivility line. Do not personalize your arguments.

Replying to this modbox in thread will be off topic  Posted By: jhunter1163

 

[Gandalfs Beard]

The American Society of Addiction Medicine according to this article.

I make a habit of re-reading threads I post on to catch things I sometimes miss. This particular link that UncaYimmy posted is particularly interesting, as UY claims it as his source for his "Traditional definition of disease."

I don't quite get it though. UncaYimmy claims that Addiction is a "Behavioural Disorder," a "Choice," not a Disease, in the "traditional sense." Is UY being Ironic, Satirical? Did he hope none of us would actually read the link? I don't know.

But here is what the link leads to:

Addiction: Defining the DiseaseWhat is a disease? The American Society of Addiction Medicine listed four criteria for defining a disease, and explained how the disease of addiction meets those criteria.
1. A disease has a biological basis. Alcohol and other drug dependency often has a genetic basis. Research with both animals and humans has shown inheritable differences in preference for a drug over water, tolerance (requiring more of a substance to get the same effect), susceptibility to seizures related to substance use, sedation effects, and other indicators of addiction. In addition, repeated use of a substance produces biological changes in the brain – molecular adaptations that hijack the functioning of critical pathways in the brain that control motivated behavior. Addiction is a brain disease.

2. A disease has identifiable signs and symptoms. Major symptoms of addiction include tolerance, withdrawal symptoms, using more of a substance than intended, unsuccessful attempts to control use, continued use despite negative consequences, and a large time investment in obtaining, using, and recovering from use. The disease is identified when several of these symptoms are present.


3. A disease has a predictable course and outcome. A number of studies describe a common pathway of addiction whose onset is marked by heavy use and social and/or legal consequences, leading to loss of control and more intense social consequences. Further along the pathway are serious problems in health, relationships, employment, the legal system, and/or other areas of life functioning. The desired outcome is complete abstinence, but short of this, it appears the natural pattern of the disease includes periods of abstinence and relapse. Unchecked, the disease often leads to death. 4. A disease’s condition is not caused by volitional acts. A feature of chemical dependence is a person’s inability to control use. It is not a matter of willpower. Still, many people deny addiction is a disease by saying that diseases ‘happen to’ a person, but addiction is caused by a person’s decisions and behavior. Other diseases, such as lung cancer, heart disease, and diabetes, may be highly affected by a person’s behavior. Yet, we still agree these are diseases. When a chemically dependent person is drinking or using, this use becomes their top priority, despite willpower to the contrary. This lack of volition is what distinguishes addiction from substance abuse.
Addiction is comparable to other chronic diseases in terms of treatment compliance and outcome. The genetic contribution to addiction is comparable to that of other diseases such as hypertension, diabetes, and asthma. In addition, patients’ compliance with a treatment regimen, and need for repeated treatment, is similar across all these diseases.

This is very puzzling.

UncaYimmy, why did you use THIS link to source your "traditional definition of disease"?

Not only does it define Addiction as a Disease, but it makes the same distinction that I make between TRUE "addiction" and substance abuse (and I would also argue "use" in general). In other words, The "Traditional definition of disease" supports my position that not all "addictions" are "diseases," not all substance use and abuse qualify as actual addiction. It doesn't support your contention that ALL "addiction" is Behavioural, but it does recognize that SOME patterns of use/abuse are Behavioural.

In fact Point #4 Directly contradicts the phrase you attached to it:

4) A disease’s condition is not caused by volitional acts. It's a brutal torturing of this criterion to include buying a bottle of Early Times and drinking shots until you pass out.

Using the above with the same sort of tortured interpretation, we could classify all sorts of things as diseases.

As you can plainly see, Point #4 of Your "traditional definition of disease" includes PRECISELY the criterion of "buying a bottle of Early Times and drinking shots until you pass out."

I'm really gobsmacked.

It's one thing to misread Research Articles and Abstracts--but THIS????

I would think you were just being deceitful by only posting the first sentence and then posting an argument that directly contradicts the rest of the paragraphs; but you posted the link too, giving us all a chance to read it in its entirety.

Way to TOTALLY botch your argument UncaYimmy!!! D'oh

Kudo's to Bookitty for being the first to catch this.

GB

 

[Gandalfs Beard]

The traditional definition of a disease says:
1) A disease has a biological basis. Everything we do has a biological basis and is related to genetics. It's a major twisting of this requirement to cite genetics as a biological basis for pouring shots of whiskey and drinking them until you're drunk. If drinking booze qualifies, then I can't think of any activity we would exclude based on this requirement, so why include it?

2) A disease has identifiable signs and symptoms. This is another interesting one. If the addict doesn't tell you about his behavior, you can't identify the symptoms. It also reduces "signs and symptoms" to include things like getting a haircut or watching football, which enables this criterion to be used to classify anything as a disease.

3) A disease has a predictable course and outcome. This is another stretch for alcoholism/addiction since it simply describes voluntary behaviors. This interpretation allows to classify many activities (going to college) as a disease.

4) A disease’s condition is not caused by volitional acts. It's a brutal torturing of this criterion to include buying a bottle of Early Times and drinking shots until you pass out.

Using the above with the same sort of tortured interpretation, we could classify all sorts of things as diseases.

I didn't offer it as evidence of the traditional definition of disease. There is no "traditional" definition. There is no official definition. The definition has morphed over the centuries. I cited it as one reasonable example of a definition for the purposes of showing how they contorted alcoholism to fit. The point is that with their own definition, they had to twist things around in such a way that virtually any behavior could be called a disease.

As for the evidence they claimed that research showed, that would entail, oh, I dunno, an actual link to the research itself. Do you not understand what it means to link to research? Do you have a link to the research? If not, then please stop wasting my time.

Why don't you stop wasting our time claiming something is a "Traditional definition of disease" and then pretending that's not what you meant after the fact.

If I hadn't re-read your exchange with Bookitty, I would have been so wrapped up in my own argument with you I would have missed this.

Thankfully, the links I posted fully support the claims in the "Traditional definition of disease" that YOU chose to post.

GB

 

[Uncayimmy]

Did you even READ what you just wrote?

Yes.

Response to Cues <> Need for Water

If you want to pretend that this study supports the NIH claim, then any study that demonstrates a strong cue response compared to water could then be referred to as a showing a craving stronger than the need for water.

 

[Uncayimmy]

So UncaYimmy, more data comes in every day that reveals that "Disorders" previously believed to be Psychological (Behavioural) Disorders are more than likely Physiologically based.

Give me a call when they start calling them diseases instead of disorders.

 

[Uncayimmy]

Why don't you stop wasting our time claiming something is a "Traditional definition of disease" and then pretending that's not what you meant after the fact.

If I hadn't re-read your exchange with Bookitty, I would have been so wrapped up in my own argument with you I would have missed this.

Thankfully, the links I posted fully support the claims in the "Traditional definition of disease" that YOU chose to post.

GB

You are correct. I should have said "a" rather than "the" traditional definition of disease used by the addiction folks.

 

[xjx388]

I now understand better your emotional attachment to calling it impossible. I realize that it's very unlikely for you view it any other way because of the emotional baggage. You want to believe that his choice to become a drifter who drank himself to death was not really a choice. Nothing I can say will dissuade you. Scientifically, you have no basis for your claim that it was impossible. You are simply arguing that because he didn't he couldn't, just as I've pointed out many times.

OK, UY, I can accept that this is my own interpretation and that I can't KNOW with 100% certainty whether or not my Uncle could have changed. Not even "Science" can claim to "know" everything with 100% certainty. However, I can look at the evidence provided by numerous studies, as well as the expert opinions and reach a reasonable conclusion that my Uncle had the biopsychosocial disease of Alcohol Dependence and that this disease made it impossible for him to control his behavior despite the rehab, love and other assistance he received.

Now, at the same time, you also have to concede that you can't KNOW with 100% certainty that he could have changed if he had chosen to. You have no studies or expert opinions to back up the idea that 100% of alcoholics can change if they choose to. Nothing, nada, zilch -only your own conviction. And obviously you won't be shaken from this belief despite the mountains of evidence and expert opinion you've been presented.

Now if you have new evidence that you feel backs up your conviction, I'd be happy to look at it. However, simply repeating your stance does nothing to sway me.

Response to Cues <> Need for Water

OK, UY if you take water (and all beverages) away from someone for one whole day, I think they would strongly crave water. Just like when you take alcohol away from someone who has a dependence, they will strongly crave their favorite adult beverage. How can you not understand this?

Give me a call when they start calling them diseases instead of disorders.

Still playing semantic games. . . The terms are synonymous and interchangeable. Disease=Disorder. Unless, of course, you can find precise medical definitions of these things that has somehow escaped me. The only person to whom such a distinction seems to matter to is you.

 

[Uncayimmy]

I'm saying that disorders and syndromes are diseases and vice versa. They are synonyms.

I can't argue with that logic. If syndromes are disorders, which includes behavioral disorders, and those are all diseases and diseases are all also disorders and syndromes, then alcoholism is a disease. Of course, it makes me wonder why you are unwilling to call it a behavioral disorder since in your mind there's no distinction. It also renders the different terms rather useless.

 

[xjx388]

I can't argue with that logic. If syndromes are disorders, which includes behavioral disorders, and those are all diseases and diseases are all also disorders and syndromes, then alcoholism is a disease. Of course, it makes me wonder why you are unwilling to call it a behavioral disorder since in your mind there's no distinction. It also renders the different terms rather useless.

Fine, it's a behavioral disorder. A behavioral disorder that can cause SOME people to have no control over their drinking. What difference does it make? Call it a "Fleegen Flaeigel" if you want to, as long as you understand that Alcoholism is a Fleegen Flaeigel that can cause SOME people to have no control over their drinking. That's why I said earlier in the thread that the answer to the question in the title of this thread is: "It doesn't matter." The terms ARE useless for the most part, except to establish the fact that the condition is an abnormality of the body, as opposed to a moral failing, lapse in judgement or "choice."

 

[Uncayimmy]

The last sentence, sure...



If you think calling me a paranoid CTer wins the argument for you, then congratulations, winner! Excellent retort!

If you were to go look at the links provided earlier in the thread, there is proof for my theory and a basis for my logic. Organizations dealing with addiction get less funding than those dealing with "alcoholism the disease." You could do research, but of course it's way easier to just call someone a .

I thought this might interest you.

http://news.sciencemag.org/scienceinsider/2010/09/advisers-say-nih-should-merge-al.html
A group of outside advisers to National Institutes of Health Director Francis Collins has recommended merging the two NIH institutes that study alcoholism and drug abuse.

Researchers supported by the $1.06 billion-a-year NIDA generally favored a merger, while those funded by the smaller ($462 million) NIAAA fretted that their areas would get less emphasis and that the legal use of alcohol would be stigmatized.

 

[bookitty]

Brain damage can cause loss of impulse control. I've even seen a specific instance of this. A friend was in an accident and sustained injuries to his skull.

For almost a year following, he was unable to control his speech. He would constantly interrupt during conversation, go off on unrelated tangents, and fixate on specific words. This was frustrating because he also suffered from aphasia and sometimes these interjection were nonsensical or incomplete. It also effected his emotions, small irritants could lead to rage or small kindness to tears.

He was lucid, aware of what was happening and aware that this made him socially awkward. He did not want to do it, but he had no control. It took a year of speech therapy and healing before he regained incomplete control. There are still remnants, but in general he's managed to overcome it.

According to UY, he should have merely not interjected while undergoing therapy. He should have had more control. He should have made the choice not to interrupt people, not to fly into a rage over a tiny mishap.

Long-term addiction and abuse can cause damage to brain in the frontal lobe, the same area affected by my friend's accident. This damage is even reversible in some cases but only after months of sobriety. If an alcoholic has reduced cognitive function, they can not be expected to fully control their behavior, especially at the beginning of treatment or in cases where treatment options are lacking. If this damage is not fully reversed by sobriety, the patient may not have the functionality needed to remain sober.

 

[Baylor]

Brain damage can cause loss of impulse control.

Phineas Gage^WP - below is a .gif of where he suffered brain damage