Is alcoholism a disease or something else?

[Zelenius]

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.

Of all the posts in this thread, this one comes the closest to answering my original question: "Is alcoholism a disease or something else?". Although it has long seemed ridiculous to call alcoholism a "disease", I can understand in some circumstances, with some sufferers it is useful to see it as a "disease". I've long thought it absurd to call a behavior a disease, and happen to agree with Gandalf that the "disease" model doesn't work for everyone called an "alcoholic".

Indeed, based on my readings of this thread and the evidence provided, and my readings from elsewhere and personal experiences, it seems clear that the real disease is not the alcoholism per se but a neurobiological dysfunction in the brain that often manifests as addictive behavior. In some other people it could just as well manifest as cocaine or gambling addiction. Perhaps it is just easier to say it's a disease to society at large than to make it seem more complicated.

It is also worth repeating that this neurological disorder that leads to alcoholism also strongly overlaps with or is one and the same with various forms of mental illness, like depression, schizophrenia and anxiety disorders. In this case, the alcoholic with depression is "self-medicating" their condition; this doesn't apply to all alcoholics though, since not all alcoholics have depression or schizophrenia.

I also happen to "sort of" agree with Unca_Yimmy. Of course drinking is a "choice" for alcoholics, but I see "choice" only at its most superficial since it is so obvious that the "choice" mechanism in all or most alcoholics has been severely compromised. Unca_Yimmy's approach may be helpful for only a few alcoholics, those whose choice mechanism can be restored through encouragement or behavioral modification.

If words of encouragement or behavioral modification was all that was needed to get alcoholics to stop drinking, we wouldn't be having this discussion. It's like trying to solve a serious hardware problem with a software solution.

 

[MikeSun5]

He had been sober for a few months...

Was the disease in remission at this time, or was he cured of it and then "caught" it again? Or was it somehow being successfully treated and the treatment failed? Or did he just choose to like his old lifestyle better even though it was bad for him?

Not to be an a-hole, but I'm still trying to reconcile the differences between disease and addiction...

 

[littleroundman]

I've often wondered exactly where the "choice" mechanism is located.

Try as I might, I simply cannot find anything more than a whole lot of chemical and electrical reactions , billions of brain synapses and trillions of cells in different regions of the human body all of which seem to contribute to a "choice" being made.

I simply cannot find a definitive answer as the where the "choice" and "free will" and "soul" and "mind" functions are located.

Then it occurs to me that if all of these functions combine somehow to produce a reaction known as "choice" or "free will" then how is it possible that each one of those "squillions" of activities takes place in perfect harmony every time they are called into action.

 

[Uncayimmy]

I also happen to "sort of" agree with Unca_Yimmy. Of course drinking is a "choice" for alcoholics, but I see "choice" only at its most superficial since it is so obvious that the "choice" mechanism in all or most alcoholics has been severely compromised. Unca_Yimmy's approach may be helpful for only a few alcoholics, those whose choice mechanism can be restored through encouragement or behavioral modification.

If words of encouragement or behavioral modification was all that was needed to get alcoholics to stop drinking, we wouldn't be having this discussion. It's like trying to solve a serious hardware problem with a software solution.

What, exactly, do you think my "approach" is? MikeSun gets it. I'm not against medication in the least, but it's still a choice to take medication. If there is an underlying pain for which a person is self-medicating, then dealing with that pain by whatever means is still a choice.

As I said before, alcoholism, unlike traditional diseases, cannot be cured surreptitiously. By that I mean you could slip some meds unknowingly to (say) someone with malaria and cure them. There's nothing you can do for an alcoholic like that. Their will, however strong or weak it is, has to be part of the cure in the form of making choices.

 

[Uncayimmy]

I've often wondered exactly where the "choice" mechanism is located.

Try as I might, I simply cannot find anything more than a whole lot of chemical and electrical reactions , billions of brain synapses and trillions of cells in different regions of the human body all of which seem to contribute to a "choice" being made.

Did you choose to try?

 

[Uncayimmy]

I've never made a blanket statement. I've said that SOME addicts are so impaired that they cannot make rational choices. The spectrum of the ability to quit drinking is from "No Problem!" to "It's Impossible!"

Now, let's look at the choices involved in getting help. The addict on the "No Problem!" side of the spectrum can just decide, "Hey, I don't want to be that person anymore!" and quit drinking. Someone in the middle can make the same commitment to change but will have a little more difficulty. Maybe they need support, medical treatment or even admission into a residential detox program. Then we have the extreme, "It's Impossible!" addict. These people have decided that they want to change, but they cannot implement the change. They try to resist alcohol but they crave it too much. They may find a few months of sobriety, but they relapse over and over. They damage themselves, their relationships and put others at risk. Yet they still can't stop. These people are beyond help.

So no blanket statement here.

UY, you keep asking me about my Uncle. I put him on the "It's impossible" part of the spectrum. I was 20 years old when he died. I didn't really know him. My father and his sisters decided he was beyond help after the 3rd or 4th time they paid for a detox program. He had been sober for a few months, lived with my Aunt and somehow got his hands on some hooch. He got so drunk he put the moves on my Aunt and her husband kicked him out. He pretty much was homeless after that and died shortly thereafter.

Now, how can you know that he could have been helped?

You just moved the goal posts, probably without even realizing it. You claimed it was impossible for him to stop drinking, yet now you're asking me how I "know" he couldn't be helped. The two are not the same. You can't really help an addict who doesn't want to be helped. That has little to do with the topic at hand.

Your uncle went in rehab multiple times, so presumably you believed at that point that it was possible for him to stop drinking. He did, in fact, stop drinking for a few months. Then, after getting drunk again and hitting on his sister-in-law, he got kicked out. He was homeless and died not too long after.

So, once again, when and on what basis did you decide it was impossible for him to stop drinking? Don't put this back on me. You apparently thought it was possible then you didn't. I want to know how and when you came to that conclusion. It would be extremely useful for rehab clinics as well as family and friends to know when it's impossible for someone so that we don't waste time and money on curing the incurable. We can just concern ourselves with palliative care.

 

[xjx388]

Human nature is to never give up on your loved ones when they are sick. We always want to believe they can change. Our beliefs dont change reality. My uncle was never going to change.

If you want to believe that he "chose" to like his old life better then fine. But again, beliefs don't change reality.

 

[Uncayimmy]

Human nature is to never give up on your loved ones when they are sick. We always want to believe they can change. Our beliefs dont change reality. My uncle was never going to change.

If you want to believe that he "chose" to like his old life better then fine. But again, beliefs don't change reality.

You still haven't answered the questions. When and on what basis did you decide it was impossible for him to stop drinking?

It doesn't matter what I "want" to believe. If it makes it easier, pretend that I want to believe you're right. Truth, I think it would be great to actually know that it's impossible for some people. It would dramatically change how we deal with the problem from medical, legal and social perspectives. It sickens me to think that people go to rehab time and again when in reality it's impossible for them to stop. That must be sheer torture for them, and it's money poured down the drain.

So, once again, when and on what basis did you decide it was impossible for him to stop drinking?

 

[bookitty]

I have to wonder if the people who see alcoholism as mere weakness of will, are the same people who wont give a starving homeless person cash because "He'll just spend it on booze."

 

[xjx388]

You still haven't answered the questions. When and on what basis did you decide it was impossible for him to stop drinking?

It doesn't matter what I "want" to believe. If it makes it easier, pretend that I want to believe you're right. Truth, I think it would be great to actually know that it's impossible for some people. It would dramatically change how we deal with the problem from medical, legal and social perspectives. It sickens me to think that people go to rehab time and again when in reality it's impossible for them to stop. That must be sheer torture for them, and it's money poured down the drain.

So, once again, when and on what basis did you decide it was impossible for him to stop drinking?

Dammit! Yimmy wants his answers!!!

I never decided anything at the time. I was a kid and didn't really care one way or the other. Now that I'm older, I can analyze the situation, combine that with the science and conclude that it was impossible. My Dad never gave up on his brother. It was a source of great sadness. He always said, let's try just one more time. But in his heart, he knew it was hopeless.

But it might not always be hopeless for everyone. If we continue the research along the lines of a biopsychosocial disease model, we might find a cure or at least much better treatment. For instance, if naltrexone had been available, it might have helped my uncle. Who knows?

 

[Uncayimmy]

Dammit! Yimmy wants his answers!!!

I never decided anything at the time. I was a kid and didn't really care one way or the other. Now that I'm older, I can analyze the situation, combine that with the science and conclude that it was impossible. My Dad never gave up on his brother. It was a source of great sadness. He always said, let's try just one more time. But in his heart, he knew it was hopeless.

But it might not always be hopeless for everyone. If we continue the research along the lines of a biopsychosocial disease model, we might find a cure or at least much better treatment. For instance, if naltrexone had been available, it might have helped my uncle. Who knows?

You still haven't answered the questions.

At what point in his life did it become impossible? I don't care how old you were when you figured it out. Was it impossible at birth? After his first sip of wine? After the first time he got drunk? The first time he missed work from a hangover? After the first stint in rehab? The second? After hitting on your aunt?

And on what basis did you make the decision that it was impossible? Just saying "science" is a non-answer. You say that some can while for some it's impossible. I am asking you how you make that distinction.

 

[Uncayimmy]

I have to wonder if the people who see alcoholism as mere weakness of will, are the same people who wont give a starving homeless person cash because "He'll just spend it on booze."

Why are you asking in this thread? After all, nobody here is arguing that it's a "mere weakness of will."

 

[Gandalfs Beard]

I have to wonder if the people who see alcoholism as mere weakness of will, are the same people who wont give a starving homeless person cash because "He'll just spend it on booze."

Just anecdotally, but in my experience the people that rant the most about "personal choice" are usually the Grinches and Political Pundits that want to defund public service programmes for the poor ("they're just lazy"), privatize Social Security ("people should be responsible for their own retirement"), cut Medicare benefits or eliminate the programme altogether, cut off unemployment benefits ("they're spoiled" as one recent Conservative candidate put it), rail on about "teenage mothers" and "welfare queens," and think that "Just Say No" bumper stickers are all they need to address the problems of society.

GB

 

[Uncayimmy]

Just anecdotally, but in my experience the people that rant the most about "personal choice" are usually the Grinches and Political Pundits that want to defund public service programmes for the poor ("they're just lazy"), privatize Social Security ("people should be responsible for their own retirement"), cut Medicare benefits or eliminate the programme altogether, cut off unemployment benefits ("they're spoiled" as one recent Conservative candidate put it), rail on about "teenage mothers" and "welfare queens," and think that "Just Say No" bumper stickers are all they need to address the problems of society.

GB

Here are a couple of anecdotes to add to your collection:

http://www.internationalskeptics.com/forums/showthread.php?postid=6688406#post6688406
http://www.internationalskeptics.com/forums/showthread.php?postid=6688534#post6688534

You might be surprised.

 

[xjx388]

You still haven't answered the questions.

At what point in his life did it become impossible? I don't care how old you were when you figured it out. Was it impossible at birth? After his first sip of wine? After the first time he got drunk? The first time he missed work from a hangover? After the first stint in rehab? The second? After hitting on your aunt?

And on what basis did you make the decision that it was impossible? Just saying "science" is a non-answer. You say that some can while for some it's impossible. I am asking you how you make that distinction.

Maybe he never had a choice from birth. Maybe he lost the ability to choose once he tasted alcohol. Maybe he lost it after years of drinking. How do you expect me to pinpoint a specific time when it went from possible to impossible? I wasn't his doctor and I don't know enough about him. Maybe he was schizophrenic, bipolar, brain damaged any number of things that could have contributed. At this point, who the heck knows?

My uncle is just an anecdote. What the science tells me is that there are brain states that arise either through genetics, environment, exposure to alcohol or a number of other factors that make it impossible for SOME extremely addicted people to change. Back to the anecdote, my uncle was a person who never changed, despite years of love, rehab and other interventions. I've reached a reasonable conclusion that he was one of those people for whom it was impossible.

That's as good an answer as you are going to get.

Now you answer. How can someone with impaired executive function be expected to make a rational choice?

 

[littleroundman]

Just anecdotally, but in my experience the people that rant the most about "personal choice" are usually the Grinches and Political Pundits that want to defund public service programmes for the poor ("they're just lazy"), privatize Social Security ("people should be responsible for their own retirement"), cut Medicare benefits or eliminate the programme altogether, cut off unemployment benefits ("they're spoiled" as one recent Conservative candidate put it), rail on about "teenage mothers" and "welfare queens," and think that "Just Say No" bumper stickers are all they need to address the problems of society.

GB

Interestingly enough, your description could be applied to SOME of the of the sub categories used by SOME organizations involved in the diagnosis, research, treatment, education and de stigmatizing of "depression"

Irritable Personality Style
Someone who has an ‘irritable’ personality style tends to be easily rattled and have low tolerance for frustration.

Self-focused Personality Style
Someone who has a ‘self-focused’ personality style tends to lack consideration and empathy for others, is often hostile and volatile in interacting with other people, and has a low threshold for frustration.

Perfectionistic Personality Style
A person with a ‘perfectionistic’ personality style tends to perceive that they’ve failed to meet their own high standards, or that somebody has criticised their performance and they feel demeaned.

There are even SOME who say that SOME depressives are their own worst enemies in that they have belief systems incongruous with the circumstances in which they find themselves.

Unfortunately, as is the case with so many of these "conditions" to date, no one has been able to provide any incontravertible evidence of exact causes or definite links.

Personally though, the fact that different experts/schools of thought can find parallels between "depression" "alcoholism" and "addictions" gives rise to more questions than answers.

 

[littleroundman]

Maybe he lost it after years of drinking

That's an interesting point.

Has anyone ever identified the moment when an alcohol related disorder ticks over from being "drinking by choice" into being "uncontrollable alcohol consumption caused by alcohol related brain damage"

Is there even a "moment" or can it sneak up on a person ???

There's a pre Christmas ad campaign running in the media here which recommends no more than 4 "standard drinks a day" for men and 2 "standard drinks" a day for women.

Could any more than those amounts cause "brain damage"

What sort of damage could be caused to smaller than average men and women who drink the "right" amount ??

 

[Uncayimmy]

Maybe he never had a choice from birth. Maybe he lost the ability to choose once he tasted alcohol. Maybe he lost it after years of drinking. How do you expect me to pinpoint a specific time when it went from possible to impossible? I wasn't his doctor and I don't know enough about him. Maybe he was schizophrenic, bipolar, brain damaged any number of things that could have contributed. At this point, who the heck knows?

You claimed quite forcefully that it was impossible for him. I'm asking how you know. So, are you saying you don't know?

My uncle is just an anecdote. What the science tells me is that there are brain states that arise either through genetics, environment, exposure to alcohol or a number of other factors that make it impossible for SOME extremely addicted people to change. Back to the anecdote, my uncle was a person who never changed, despite years of love, rehab and other interventions. I've reached a reasonable conclusion that he was one of those people for whom it was impossible.

In other words you cannot articulate how you came to this conclusion. Is that correct?

Now you answer. How can someone with impaired executive function be expected to make a rational choice?

Impairment <> Unable

I invite you to respond to post #668 where this is addressed by someone far more qualified than myself.

In the meantime, it appears you are assuming that drinking is an irrational choice. In itself drinking is not irrational. Even with a chronic alcohol abuser, any single choice to drink is not necessarily irrational. Every day every one of us makes choices based on numerous (even countless) factors. We weigh short term and long term pros and cons, often subconsciously. Who are you to say that it's "irrational" for someone to get hammered? In the grand scheme of things, what's one evening of getting drunk? I can get sober tomorrow - one more binge won't make a hill of beans of difference.

Getting drunk feels good. Maybe it satisfies a craving. Maybe it makes me forget about some emotional pain. Maybe it lets me escape from stress. Hell, maybe I just don't like my job and if I show up hungover one more time they will fire my ass, which is fine by me anyway - the boss is a bastard.

We "sober" people look at a long-term pattern of behavior and conclude that it's "irrational" to live your life as a drunk. In reality, it's a series of individual decisions that, in my not so humble opinion, make pretty good sense at the time. It's sucks to give up short term benefits for long term benefits.

This is why the paradigm of "choicers" is so superior compared to the "it's impossible" crowd. We start with the person acknowledging that no disease is making them get money, procure liquor, hide it from a spouse, and pour drinks. That's their decision, and at the time, it probably seems pretty rational. When the person decides they don't want to be the person who engages in a long-term pattern of self-destructive behavior, then that person can attack the problem head on, whatever it is.

If it's depression, treat it. PTSD? Treat it. Stress? Treat it. Environment? Change it. Intense cravings? Try some medications and stop reinforcing the craving. It just feels good? Find something else to do. Just an unthinking habit? Make new thinking habits. Chances are it's probably a combination of several things.

It may take years to get on track, but the only constant in all of this is figuring out why you're making the choices you're making and finding ways to make better choices for the rest of your life by using any and all available resources.

 

[Gandalfs Beard]

Here are a couple of anecdotes to add to your collection:

http://www.internationalskeptics.com/forums/showthread.php?postid=6688406#post6688406
http://www.internationalskeptics.com/forums/showthread.php?postid=6688534#post6688534

You might be surprised.

Thanks for the heads up. I AM surprised (pleasantly). Finally, something that you and I can agree on 100%.

Still, I think that your posts on the other thread are incongruous with your points on this thread (and the "Calories" thread).

Though if you think about it, it's only a couple of points (big ones to be sure) that I've vehemently disagreed with you on. I have previously stated that I agree in part with you in certain circumstances.

I expect that as the debate on the other thread continues, certain "alliances" will be reversed.

Doesn't change my position vis a vis THIS topic though.

GB

 

[xjx388]

It's OK GB, we can't agree on everything! And, honestly, I'm not 100% sure what my position will end up being on the other thread.