Is alcoholism a disease or something else?

[Uncayimmy]

How does a doctor decide that treatment is no longer an option for any disease?

Alcoholism is a disease.
But traditionally diseases are not optional behaviors.
Well, some alcoholics can control it, but for some it's impossible.
Okay, we agree that some can control it. How do you distinguish those who can't.
Just like we can for any other disease - the treatment doesn't work.
But traditionally diseases aren't optional behaviors.

When the treatment no longer has an effect.

Oh, so you're saying it does work for a while, then it doesn't? Does that mean it's a choice when it does work and not a choice when it doesn't work?

If it were cancer, there may come a point where further chemo or radiation will only weaken the patient, or a tumor might be inoperable.

Nobody can voluntarily stop growing a tumor.

 

[Uncayimmy]

Why ???

If you know, why wouldn't you tell everyone? Why not shout it from the rooftops? We can stop locking up criminals who have no choice. Instead of forcing them into to treatment that will never work (because it's "impossible" for them to stop), we don't waste valuable resources. We can work on palliative care instead. Billions are spent on addiction. If it's impossible for some to stop, we could have a buttload of money.

But we know the real reason why you won't tell. Not a single one of you has been able to articulate how you know because you really don't know. As Steven E. Hyman, MD, Provost of Harvard University and Professor of Neurobiology at Harvard Medical School - a school which, I should mention, says alcoholism has a spontaneous remission rate of 50%, says, "all current mainstream formulations agree that addiction diminishes voluntary behavioral control. At the same time, none of the current views conceives of the addicted person to be devoid of all voluntary control and thus absolved of all responsibility for self-control."

The "Mission Impossible" crowd just wants to believe that some people "cannot" because it makes them sleep better at night. It's no different than the belief in psychics.

 

[littleroundman]

Not a single one of you has been able to articulate how you know because you really don't know.

Geez,

how many ways can posters say "I don't know" or "no one knows"
"now one knows in every particular case" or "no one can possibly know given the size and diversity of the subject group"

How can "one of you" articulate something that not all the "one of you" agree upon ???

For that matter, how does one "articulate" what one admits one doesn't know ??

What part of answering the OP question: "Is alcoholism a disease or something else" as "both" makes a poster "one of you" ????

"As Steven E. Hyman, MD, Provost of Harvard University and Professor of Neurobiology at Harvard Medical School - a school which, I should mention, says alcoholism has a spontaneous remission rate of 50%"

so he's saying that 50% of his definition of "alcoholism" has a spontaneous remission rate.

Excellent news.

50% of all the rest of the "alcoholism" would be what number of cases with what reason for lack of spontaneous remission ????

 

[bookitty]

Again, it depends on the individual.

The choice crowd says "You can not be helped until you decide to help yourself." Which implies that merely wanting to not be an addict is all it takes. If you want it bad enough, you'll be healed.

Those of us who understand that addiction is the end result of a complex series of event that vary widely between individuals are open to the idea that it might take more than that.

It is true that the "want it really, really bad" approach will work with an unknown percentage of addicts. Another group might be helped by AA. A different group might not be able to overcome addiction until they address other underlying issues such as depression or physical trauma. Another group might have no interest in treatment at all because these issues haven't been addressed. If they get outside help with addressing an underlying issue, they may then be able to recover from addiction. There are those who are not interested in recovering but are sent to rehab by the court and manage to stay clean afterward.

Then there are those who try everything and, regardless of how much they would like to overcome addiction, fail repeatedly even after treatment.

We have only started to understand how various factors can influence addiction. Like most neurological studies, we still don't have an absolute understanding or why some people become addicts in the first place. Until we do, we won't have an absolute understanding on how to help them.

 

[Uncayimmy]

how many ways can posters say "I don't know" or "no one knows"

They didn't say they didn't know. They said flat out that they know it's impossible for some people, but when push comes to shove, they don't know.

 

[littleroundman]

They didn't say they didn't know. They said flat out that they know it's impossible for some people, but when push comes to shove, they don't know.

THEY ???

Which "THEY" would that be ????

Let's be specific here, we wouldn't want ANOTHER 10 wasted pages discussing the/a definition now, would we ???

To use internet forum "debate" protocols, please provide links to the exact posting/s in which THEY said flat out that they know it's impossible for some people.

Maybe it's an Australian thing, but, in Oz, more than one example would immediately cancel out any use of the word "all" when referring to any group, much less when referring to a group numbering in the millions.

This would also allow readers to determine that the remarks were not taken out of context, which, believe it or not, is a tactic used by some of the THEY who persist in acting as forum bullies.

 

[Uncayimmy]

The choice crowd says "You can not be helped until you decide to help yourself." Which implies that merely wanting to not be an addict is all it takes.

Implies to whom? You? Well, that's on you, Bookitty. Name any other facet of life outside of addiction where saying, "You cannot be helped until you decide to help yourself" is taken to mean, "merely wanting it is all that it takes." That's an incredibly ridiculous implication to take. Nothing in life comes simply because you want it.

Those of us who understand that addiction is the end result of a complex series of event that vary widely between individuals are open to the idea that it might take more than that.

More straw men. I mean, seriously, why do you keep throwing this kinda crap at me? I was in this thread long before you, and I and every other person in this thread has agreed that it's a complex issue and unique to the individual. You've been told this already, so why do you keep repeating it back to me as if I don't believe it?

Seriously. What are you driving at? That I'm lying and don't really believe it? What? Please tell me so I can say whatever it is you want me to say to get you stop.

Then there are those who try everything and, regardless of how much they would like to overcome addiction, fail repeatedly even after treatment.

Sure, they'd like to overcome their addiction. Who really wants all the ill effects of abusing alcohol? Do you think anybody would stop drinking if there weren't negative effects? That's the crucial point you and others keep ignoring. You're looking at just one side of the equation: The desire to not have the ill effects of substance abuse. You completely ignore the other side figuring, "Gee. How can anybody want to end up unemployed and suffering from a diseased liver, brain damage, hangovers and alienation from family? It must therefore be impossible for them to stop!"

********. The other half of the equation is that they enjoy drinking. The "rewiring of the brain" you referred to is the result of the pleasure centers being stimulated. It's perfectly sane and rational to want it. It's perfectly sane and rational to want to keep hanging out with your substance abusing friends. It's rational to want to blow off steam, relieve stress, avoid emotional pain and escape responsibility.

Nothing in known medical science says that voluntary control is lost. You just want it to be lost. The fact is that, as Dancing David said, addicts don't want to deal with the consequences of their decisions. You and others completely ignore all the positives of choosing to remain a substance abuser. More importantly, you ignore the fact that most substance abusers get sober for a while - sometimes for months or years at a time. Then they rationalize going back to it. You know, they miss their friends. They miss the high or want to feel numb instead of dealing with guilt, depression, anger, stress or whatever it is at the time.

You figure that no rational person would make self-destructive choices like that. Well, you figure some do, but not all of them. You can't say which ones because you have no evidence. It's just a feeling you have.

Yeh, it's a complex issue unique to every individual, but it starts with choosing to change your life around. There is no disease that makes you acquire money, go to a liquor store, bring it home, and get so wasted you pass out. You have to choose to stop doing it as the first step. Implementing that choice can be extremely difficult, but people do it all the frigging time. They have for centuries.

It's far easier today than it has ever been because of the medical assistance. Problem is, the disease mentality has made it worse. People figure it's something that happened to them, like malaria, rather than being a voluntary behavior that needs to be confronted with brutal honesty. Instead, responsibility is put on the backs of caregivers, who are helpless if you don't want to change.

If you want to remove the "stigma" associated with addiction, that's a laudable goal. Calling it a disease may lessen the stigma, but in the long run it leads to a worsening problem of addiction.

 

[littleroundman]

Nothing in known medical science says that voluntary control is lost.

Excuse me ???

NOTHING ???

As in "not one thing" ???

Anywhere ???

Ever ????

Golly gee whillikers, that DOES put a different spin on things, doesn't it ???

 

[Uncayimmy]

THEY ???

Which "THEY" would that be ????

Let's be specific here, we wouldn't want ANOTHER 10 wasted pages discussing the/a definition now, would we ???

To use internet forum "debate" protocols, please provide links to the exact posting/s in which THEY said flat out that they know it's impossible for some people.

Here ya go! Merry Christmas!

If you want to subscribe to the theory that people have choices, then that's fine. You're essentially wrong, but superficially correct. In reality, people are dealt their genetic hands and play them out. It's impossible for some people to control their behavior and it's easy for others. You help the ones you can.

you are not smarter than those in the medical field that think Genetic Predisposition DOES play a role in SOME people who DO find it impossible to control their drinking?

For all practical purposes, yes it was impossible for that person.

Because the brain is changed by the addiction, many of the impulses that lead an addict to use or relapse are involuntary. It's impossible to say that all their behavior can be based on choice.

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.

Do you need more?

 

[littleroundman]

Can we be a bit more specific here ??

You "seem" to have provided some out of context quotes which don't "appear" to me to "prove" your understanding of what the relevant poster/s said.

For example, in this quote you've provided from a Gandalfs' Beard post:

you are not smarter than those in the medical field that think Genetic Predisposition DOES play a role in SOME people who DO find it impossible to control their drinking?

It certainly SEEMS that GB is, in fact, making the statement that "you" as in: "UncaYimmy" "are not smarter than those in the medical field that think Genetic Predisposition DOES play a role in SOME people who DO find it impossible to control their drinking?"

No mention (within that extract at least) of anything which indicates anything about GB personall feelings.

In fact, if I had to guess, it certainly APPEARS as if GB is doing his or her best to avoid making what could be considered a personal attack.

Instead he APPEARS to be pointing out there exists within the medical field SOME people who believe SOME things WRT to SOME people.

 

[Uncayimmy]

Can we be a bit more specific here ??

You "seem" to have provided some out of context quotes which don't "appear" to me to "prove" your understanding of what the relevant poster/s said.

For example, in this quote you've provided from a Gandalfs' Beard post:



It certainly SEEMS that GB is, in fact, making the statement that "you" as in: "UncaYimmy" "are not smarter than those in the medical field that think Genetic Predisposition DOES play a role in SOME people who DO find it impossible to control their drinking?"

No mention (within that extract at least) of anything which indicates anything about GB personall feelings.

In fact, if I had to guess, it certainly APPEARS as if GB is doing his or her best to avoid making what could be considered a personal attack.

Instead he APPEARS to be pointing out there exists within the medical field SOME people who believe SOME things WRT to SOME people.

So, you do need more. Okay.

Yet many people are literally unable to make those "choices" due to their choice inhibiting problems, and end up in jail, a gutter, or dead.

Merry Christmas!

 

[bookitty]

Implies to whom? You? Well, that's on you, Bookitty. Name any other facet of life outside of addiction where saying, "You cannot be helped until you decide to help yourself" is taken to mean, "merely wanting it is all that it takes." That's an incredibly ridiculous implication to take. Nothing in life comes simply because you want it.


More straw men. I mean, seriously, why do you keep throwing this kinda crap at me? I was in this thread long before you, and I and every other person in this thread has agreed that it's a complex issue and unique to the individual. You've been told this already, so why do you keep repeating it back to me as if I don't believe it?

Seriously. What are you driving at? That I'm lying and don't really believe it? What? Please tell me so I can say whatever it is you want me to say to get you stop.


Sure, they'd like to overcome their addiction. Who really wants all the ill effects of abusing alcohol? Do you think anybody would stop drinking if there weren't negative effects? That's the crucial point you and others keep ignoring. You're looking at just one side of the equation: The desire to not have the ill effects of substance abuse. You completely ignore the other side figuring, "Gee. How can anybody want to end up unemployed and suffering from a diseased liver, brain damage, hangovers and alienation from family? It must therefore be impossible for them to stop!"

********. The other half of the equation is that they enjoy drinking. The "rewiring of the brain" you referred to is the result of the pleasure centers being stimulated. It's perfectly sane and rational to want it. It's perfectly sane and rational to want to keep hanging out with your substance abusing friends. It's rational to want to blow off steam, relieve stress, avoid emotional pain and escape responsibility.

Nothing in known medical science says that voluntary control is lost. You just want it to be lost. The fact is that, as Dancing David said, addicts don't want to deal with the consequences of their decisions. You and others completely ignore all the positives of choosing to remain a substance abuser. More importantly, you ignore the fact that most substance abusers get sober for a while - sometimes for months or years at a time. Then they rationalize going back to it. You know, they miss their friends. They miss the high or want to feel numb instead of dealing with guilt, depression, anger, stress or whatever it is at the time.

You figure that no rational person would make self-destructive choices like that. Well, you figure some do, but not all of them. You can't say which ones because you have no evidence. It's just a feeling you have.

Yeh, it's a complex issue unique to every individual, but it starts with choosing to change your life around. There is no disease that makes you acquire money, go to a liquor store, bring it home, and get so wasted you pass out. You have to choose to stop doing it as the first step. Implementing that choice can be extremely difficult, but people do it all the frigging time. They have for centuries.

It's far easier today than it has ever been because of the medical assistance. Problem is, the disease mentality has made it worse. People figure it's something that happened to them, like malaria, rather than being a voluntary behavior that needs to be confronted with brutal honesty. Instead, responsibility is put on the backs of caregivers, who are helpless if you don't want to change.

If you want to remove the "stigma" associated with addiction, that's a laudable goal. Calling it a disease may lessen the stigma, but in the long run it leads to a worsening problem of addiction.

Yes, there are people who do not overcome addiction because they don't want to.

For most people it's more complicated. Addiction permanently affects the pleasure centers of the brain. After a long period of abuse they only respond to the substance that is being abused. Normal stimulus that provides satisfaction like food, affection, or achievement is no longer effective. After quitting, the brain can readjust but those pathways do not go back to their pre-addiction state. It takes time to relearn to enjoy normal stimulus. In the meantime, there is no reward for quitting. None of the logical benefits to quitting - health, relationships, employment - provide a sense of well-being.

The addict has no control over this part of the process. They can not choose to find satisfaction in a fine meal or conversation. They can't just decide that going for a run will give them the same reward. Their brain has been damaged by abuse and will not respond in a normal way.

After an addict has been clean for a while, they may feel that they have some control over the substance. Because they are not getting satisfaction from normal stimuli, they are particularly susceptible to relapsing. If the addict slips and returns to the abused substance, they are rewarded by their own brain. This can lead to another cycle of abuse, further damaging the pathways of the brain.

If a person suffers brain damage from a head trauma, they may never regain full functionality. Sometimes the damage is minimal, lasting effects may be no worse than occasional aphasia or mood swings. No one would expect this person to overcome these by force of will. They will expect them to be managed by medication or therapy if necessary.

An addict has also suffered permanent damage to the brain. The only difference is that they may have chosen to damage themselves. Because they are the cause of the damage, they are expected to to control it. The majority can but they also need to be helped by medication or therapy. Simply stopping the substance abuse is only the first step. Hopefully, as we learn more about how the brain functions, we'll find ways to mitigate the damage and help people recover more quickly and more thoroughly.

 

[littleroundman]

For all practical purposes, yes it was impossible for that person.

I must apologize for doubting whether or not the example you provided was valid or not.

I didn't realize you knew XJXs' uncle and were there at the time.

Hopefully you can understand the reasons for my jumping to that conclusion.

Without knowledge of your relationship with the gentleman, it certainly could appear that you would have no way of knowing the full details of the events which transpired without relying on the those provided on a public internet forum by the poster him/herself.

I wonder if the term "impossible for that person" could have been included in a prognosis or diagnosis issued by someone possessed of superior experience/qualification/standing/authority than those immediately involved.

 

[littleroundman]

Yes, there are people who do not overcome addiction because they don't want to.

Just as there are people who deliberately become alcoholics because they want to.

As hard as it may be for some to believe, there are people who have deliberately contracted HIV and others who deliberately practice unsafe sex with HIV+ partners as part of a "Russian Roulette" type game.

What "I" believe or would like to believe is probable and/or possible has nothing to do with answering the OP question.

 

[Uncayimmy]

For most people it's more complicated.

What part of the following did you not understand?

More straw men. I mean, seriously, why do you keep throwing this kinda crap at me? I was in this thread long before you, and I and every other person in this thread has agreed that it's a complex issue and unique to the individual. You've been told this already, so why do you keep repeating it back to me as if I don't believe it?

Seriously. What are you driving at? That I'm lying and don't really believe it? What? Please tell me so I can say whatever it is you want me to say to get you stop.

 

[lionking]

Italics mean what?

 

[Uncayimmy]

Italics mean what?

Click the little red arrows next to the member name after Originally Posted By and find out why I used the past tense.

 

[Dancing David]

How does a doctor decide that treatment is no longer an option for any disease? When the treatment no longer has an effect. If it were cancer, there may come a point where further chemo or radiation will only weaken the patient, or a tumor might be inoperable.

It depends on the individual, on what treatment has already been tried, on what (if any) options are still available.

I would add that in the substance abuse field there are a number of factors that lead to people not receiving treatment.

-first off , usually a provider will not deny treatment, that is unethical

in residential (but this applies to community based treatment as well):

-fiscal concerns, despite the claims that treatment is provided because it is lucrative, most people can not afford private treatment facilities, there is a huge demand of about 20 to 1 for treatment beds in subsidized/sliding scale treatment facilities, so the first reason that people get bounced in non-cooperation and violation of program guidelines. There are often 6 month to year wait lists for treatment, so there is tremendous pressure to bounce people who don't cooperate
-safety concerns (applies more to residential but also to community) dangerous behaviors, threats, weapons, contraband , these are all reasons to be denied treatment
-past history : violence and battery are often a reason to have a 'trespass bar' on an individual
-active defiance of the programs: if someone is rude and belligerent about even the idea of sobriety they will usually be asked to leave
-court orders: many people in treatment are under 'drops' orders, if they test positive they can and will be bounced from treatment

The main issue is the substance abuse treatment system is way under funded, understaffed and under available, so there is huge pressure to bounce people.

Also as in any treatment, the patient/client can always refuse.

 

[Dancing David]

Yes, there are people who do not overcome addiction because they don't want to.

Yup, first rule, some people don't think it is a problem. So it isn't, the patient/client has autonomy.

For most people it's more complicated. Addiction permanently affects the pleasure centers of the brain.

It has been a while since I read up on that literature, do you have recent studies that show the permanency?

After a long period of abuse they only respond to the substance that is being abused. Normal stimulus that provides satisfaction like food, affection, or achievement is no longer effective. After quitting, the brain can readjust but those pathways do not go back to their pre-addiction state.

That is what I am curious about, often as in depression it is system response that is re-regulated, so I am curious, I haven read the stuff for about ten years.

It takes time to relearn to enjoy normal stimulus. In the meantime, there is no reward for quitting. None of the logical benefits to quitting - health, relationships, employment - provide a sense of well-being.

The addict has no control over this part of the process. They can not choose to find satisfaction in a fine meal or conversation. They can't just decide that going for a run will give them the same reward. Their brain has been damaged by abuse and will not respond in a normal way.
[/quote]
A great subject, I have found that it is the biggest issue in the first month, but I worked with a small set.

After an addict has been clean for a while, they may feel that they have some control over the substance.

The wolf is at the door.

Because they are not getting satisfaction from normal stimuli, they are particularly susceptible to relapsing. If the addict slips and returns to the abused substance, they are rewarded by their own brain. This can lead to another cycle of abuse, further damaging the pathways of the brain.

That is also something I am curious about in terms of the recent literature, the 'damage' part, do you mean from the alcohol toxicity or the other processes?

If a person suffers brain damage from a head trauma, they may never regain full functionality. Sometimes the damage is minimal, lasting effects may be no worse than occasional aphasia or mood swings. No one would expect this person to overcome these by force of will. They will expect them to be managed by medication or therapy if necessary.

And extensive rehabilitation, short term and long term.

An addict has also suffered permanent damage to the brain.

This is sort of true for alcohol, do you have literature on other substances.?

The only difference is that they may have chosen to damage themselves. Because they are the cause of the damage, they are expected to to control it.

Well, this sort of stigma applies also to smoking and some type II diabetics as well.

The majority can but they also need to be helped by medication or therapy. Simply stopping the substance abuse is only the first step. Hopefully, as we learn more about how the brain functions, we'll find ways to mitigate the damage and help people recover more quickly and more thoroughly.

It sure requires patience and perseverance, about the same level of rehab and long term intervention as domestic violence.

 

[Marcus]

If you want to remove the "stigma" associated with addiction, that's a laudable goal. Calling it a disease may lessen the stigma, but in the long run it leads to a worsening problem of addiction.

This.