Is alcoholism a disease or something else?

[Dancing David]

The main issue that I have is that while I beleive in free will, there are many factoprs which drive addiction

So I hate the moral model of addiction, it is not a moral failing it is a long series of less than healthy choices often driven by other factors.

The self medication issue is a very widespread driver.

Addicts will usually feel worse for their sobriety, they have to face those uncomfortable events which have been driving their addiction, that is why the life style changes are so important.

 

[littleroundman]

The main issue that I have is that while I beleive in free will, there are many factoprs which drive addiction

In your experience, is there an identifiable point at which alcohol misuse tips over into becoming a clinically diagnosed alcohol related brain impairment (ARBI) and/or acquired brain injury.

My understanding is that any decline in cognitive functioning is "normally" gradual (if anything related to humans can be acceptably described as being "normal")

AFAIK, while alcohol related brain impairment is more likely to occur if a person drinks heavily on a regular basis over many years, what is commonly referred to as "binge drinking" or "heavy episodic drinking" can lead to ARBI in a relatively short period of time, if the drinking is excessive enough.
This appears to occur more often in the young.

Whichever route is taken, ARBI has been associated with changes in cognition, Cerebellar atrophy, Frontal lobe dysfunction, Frontal lobe dysfunction, Korsakoff’s amnesic syndrome, Peripheral neuropathy and Wernicke’s encephalopathy.

Are you aware of any clinical testing currently available in the US which can determine if "alcoholism" in a subject began before or after ARBI or an acquired brain injury began or was clinically diagnosed ??????

 

[xjx388]

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.

Cite me proof that the disease model of addiction has led to a worsening of the problem of addiction.

 

[Furcifer]

Cite me proof that the disease model of addiction has led to a worsening of the problem of addiction.

It might not have worsened the problem, but I can tell you as a supervisor in Union shops, it has led to ridiculous costs for companies for "treatment".

A guy shows up to work drunk, endangers his fellow workers, gets caught, and winds up on a 4 week paid vacation due to his "disease".

People are less inclined to change their behaviour knowing it's a "disease" and knowing they will be treated like a cancer patient instead of an irresponsible bum. I've seen it abused as I'm sure many others have.

 

[MikeSun5]

Cite me proof that the disease model of addiction has led to a worsening of the problem of addiction.

Watch it there, now.... we weren't discussing the "disease model of addiction," only the "disease model of alcoholism." It's important to distinguish between the two. As per the majority of the "alcoholism = disease" arguments, addiction in general is NOT a disease, while alcoholism is. According to the NIH, the AMA, and many others, alcoholism is separate from addiction. I'll give you the benefit of the doubt in this case and assume you weren't intentionally convoluting the two in order to craft a strawman.... As far as the proof you're looking for, you most likely knew when you were typing that sentence that there's no evidence showing that calling alcoholism a disease created more addicts. I don't see why that's a far fetched idea though... calling alcoholism a disease sure as hell gave many addicts a great excuse for not stopping.

If I said it once, I've said it a hundred times in this thread: we need consistency, people. If ALL addictions are diseases, fine. Alcoholism would be a disease. If that is the case, then these are also diseases: addictions to coffee, cigarettes, gambling, this forum, shopping, overeating, crack, video games, porno, exercise, work, etc. All diseases.
If addictions are NOT diseases, fine. Alcoholism would simply be defined as "an addiction to alcohol." Then it would be up to the diagnosed individual's doctor and/or shrink to determine the severity of the person's addiction and the best route to break/treat it. I don't see why this is so hard for people to understand. I know why it's hard for health organizations to understand, though. I'd much rather have $4million of my own funding for a disease than have to split $6million with addiction groups. The choice is super easy in that context.

 

[Furcifer]

If I said it once, I've said it a hundred times in this thread: we need consistency, people. If ALL addictions are diseases, fine. Alcoholism would be a disease. If that is the case, then these are also diseases: addictions to coffee, cigarettes, gambling, this forum, shopping, overeating, crack, video games, porno, exercise, work, etc. All diseases.
If addictions are NOT diseases, fine. Alcoholism would simply be defined as "an addiction to alcohol." Then it would be up to the diagnosed individual's doctor and/or shrink to determine the severity of the person's addiction and the best route to break/treat it.

I think that's a pretty good summary. I've no idea if it is or isn't, I've seen the disease model used as a cop out, but that doesn't mean it can't be. Alcohol isn't particularly addictive as a substance, more of a social or psychological addiction than a physical one. Not that it can't be a physical addiction, but so can Chapstick or Sunglasses for that matter. It really boils down to being prepared to accept every addiction as a disease, and I really don't think that's true.

 

[Uncayimmy]

It might not have worsened the problem, but I can tell you as a supervisor in Union shops, it has led to ridiculous costs for companies for "treatment".

A guy shows up to work drunk, endangers his fellow workers, gets caught, and winds up on a 4 week paid vacation due to his "disease".

People are less inclined to change their behaviour knowing it's a "disease" and knowing they will be treated like a cancer patient instead of an irresponsible bum. I've seen it abused as I'm sure many others have.

Exactly.

I can think of three "diseases" that are the direct result of behavior: Type 2 diabetes, obesity, and alcoholism. Statistically these problems are more prevalent since they became "diseases." With the first two we have medical treatments that lessen the negative consequences of the behavior, but the behavior remains unchanged.

For diabetics there are a number of treatment options that lessen the effects of insulin resistance. For the morbidly obese, the only "treatment" that works is surgery. "Success" apparently means being merely obese instead of morbidly obese. Physically we make them incapable of consuming enough food to remain morbidly obese, but the eating and exercise patterns remain largely unchanged.

All we did was lessen the consequences of bad choices. I find it amazing that xjx388 is okay with paying to treat these as medical conditions yet is willing to let his family die than accept tax dollars for health care.

We have spent billions on alcohol treatment, but the problem still remains. "Successful" drugs for treatment are only "successful" because it's defined as a statistically significant change in number of excessive drinking days or time before relapse. It's a ridiculous measure of effectiveness.

More importantly, as you describe, the disease model gets abused. It puts the onus on caregivers, or in your example, employers. So, instead of getting fired from a job, the person gets all-expenses paid treatment while your company has to hold his job open for him. This "treatment" will most likely only result in a slightly longer period of time before he shows up for work drunk again.

 

[Dancing David]

In your experience, is there an identifiable point at which alcohol misuse tips over into becoming a clinically diagnosed alcohol related brain impairment (ARBI) and/or acquired brain injury.

My understanding is that any decline in cognitive functioning is "normally" gradual (if anything related to humans can be acceptably described as being "normal")

AFAIK, while alcohol related brain impairment is more likely to occur if a person drinks heavily on a regular basis over many years, what is commonly referred to as "binge drinking" or "heavy episodic drinking" can lead to ARBI in a relatively short period of time, if the drinking is excessive enough.
This appears to occur more often in the young.

Whichever route is taken, ARBI has been associated with changes in cognition, Cerebellar atrophy, Frontal lobe dysfunction, Frontal lobe dysfunction, Korsakoff’s amnesic syndrome, Peripheral neuropathy and Wernicke’s encephalopathy.

Are you aware of any clinical testing currently available in the US which can determine if "alcoholism" in a subject began before or after ARBI or an acquired brain injury began or was clinically diagnosed ??????

Sorry I was just a mental health case manager who has a heavy proportion of MISA (mentally ill substance abusers) on my case load and was involved in a MISA group. The neurological issue is not one I can answer.

 

[Dancing David]

It might not have worsened the problem, but I can tell you as a supervisor in Union shops, it has led to ridiculous costs for companies for "treatment".

A guy shows up to work drunk, endangers his fellow workers, gets caught, and winds up on a 4 week paid vacation due to his "disease".

People are less inclined to change their behaviour knowing it's a "disease" and knowing they will be treated like a cancer patient instead of an irresponsible bum. I've seen it abused as I'm sure many others have.

Wow, here you have to pay for it yourself. And you sure won't be treated like a cancer patient.

 

[Dancing David]

According to the NIH, the AMA, and many others, alcoholism is separate from addiction.

Could you cite that?

 

[Furcifer]

Wow, here you have to pay for it yourself. And you sure won't be treated like a cancer patient.

Are you sure about that? I would be surprised if the Big 3 didn't pay in the US like they do here in Canada, but the CAW and the UAW have different contracts so it's possible.

Since alcoholism was even rumored to be a disease the Union was pushing to have people treated as such. Guys on the line literally laughed at being caught (the local treatment facility was referred to as "Plant 1" our plant number being 6). The nature of the jobs means there's very little chance of someone getting injured on the job because someone was drunk. That meant it was hard to dismiss someone for being drunk at work and endangering others, at least "directly". It took a suspension and treatment and repeated offenses to get someone fired for it.

I only had to deal with one guy that had skin cancer and he had a harder time getting time off for treatment than an alcoholic. I think he had to use sick days, but the guy in treatment for alcohol got SUB and something from the company. Ridiculous. I'm just saying a guy busted for alcohol knew he was getting 4 or 6 weeks off at 95% pay, the guy with cancer didn't know what to expect.

Alcoholism is the only disease I know people brag about having. I'm not saying it is or isn't, but if it is they really need a better way of diagnosing it because a lot of people are faking it or using it as an excuse.

 

[xjx388]

Watch it there, now.... we weren't discussing the "disease model of addiction," only the "disease model of alcoholism." It's important to distinguish between the two. As per the majority of the "alcoholism = disease" arguments, addiction in general is NOT a disease, while alcoholism is.

Not sure where you get this idea from. Addiction to any substance is considered a disease. But this isn't really germane.

According to the NIH, the AMA, and many others, alcoholism is separate from addiction.

Not sure where you get this. If you mean that "alcoholism" is just an abstraction and that "alcohol dependence" is the correct term then fine.

I'll give you the benefit of the doubt in this case and assume you weren't intentionally convoluting the two in order to craft a strawman.... As far as the proof you're looking for, you most likely knew when you were typing that sentence that there's no evidence showing that calling alcoholism a disease created more addicts. I don't see why that's a far fetched idea though... calling alcoholism a disease sure as hell gave many addicts a great excuse for not stopping.

Do you have proof that calling it a disease gave many addicts an excuse for not stopping? It's been mentioned many times and it's really nothing more than an opinion.

If I said it once, I've said it a hundred times in this thread: we need consistency, people. If ALL addictions are diseases, fine. Alcoholism would be a disease. If that is the case, then these are also diseases: addictions to coffee, cigarettes, gambling, this forum, shopping, overeating, crack, video games, porno, exercise, work, etc. All diseases.

If someone is watching porn to an extent that it interferes with their life, then yeah, I would say they are diseased. But maybe not quite in the same way an alcoholic is. Separate discussion.

 

[Furcifer]

Not sure where you get this idea from. Addiction to any substance is considered a disease.

No it isn't. As far as I know the criteria for an addiction being considered a disease is only met by opioid addiction. Alcohol addiction or dependence is considered clinically as a disorder according to the DSM.

I haven't read the entire thread so my apologies if this has been discussed. You seem to subscribe to the disease model which clearly isn't universally accepted, and is the minority view.

 

[Dancing David]

Are you sure about that? I would be surprised if the Big 3 didn't pay in the US like they do here in Canada, but the CAW and the UAW have different contracts so it's possible.

Since alcoholism was even rumored to be a disease the Union was pushing to have people treated as such. Guys on the line literally laughed at being caught (the local treatment facility was referred to as "Plant 1" our plant number being 6). The nature of the jobs means there's very little chance of someone getting injured on the job because someone was drunk. That meant it was hard to dismiss someone for being drunk at work and endangering others, at least "directly". It took a suspension and treatment and repeated offenses to get someone fired for it.

I have a union contract, intoxication at work is grounds for dismissal. I am no auto worker however.

I only had to deal with one guy that had skin cancer and he had a harder time getting time off for treatment than an alcoholic.

That sucks.

I think he had to use sick days, but the guy in treatment for alcohol got SUB and something from the company. Ridiculous. I'm just saying a guy busted for alcohol knew he was getting 4 or 6 weeks off at 95% pay, the guy with cancer didn't know what to expect.

Alcoholism is the only disease I know people brag about having. I'm not saying it is or isn't, but if it is they really need a better way of diagnosing it because a lot of people are faking it or using it as an excuse.

Could be that those union contracts allow it, in most cases in the US) the employer is under no obligation to pay for treatment, I am lucky to have an HMO, but I have a whopping co-pay for that. Most insurance won't cover it.

 

[bookitty]

Are you sure about that? I would be surprised if the Big 3 didn't pay in the US like they do here in Canada, but the CAW and the UAW have different contracts so it's possible.

Since alcoholism was even rumored to be a disease the Union was pushing to have people treated as such. Guys on the line literally laughed at being caught (the local treatment facility was referred to as "Plant 1" our plant number being 6). The nature of the jobs means there's very little chance of someone getting injured on the job because someone was drunk. That meant it was hard to dismiss someone for being drunk at work and endangering others, at least "directly". It took a suspension and treatment and repeated offenses to get someone fired for it.

I only had to deal with one guy that had skin cancer and he had a harder time getting time off for treatment than an alcoholic. I think he had to use sick days, but the guy in treatment for alcohol got SUB and something from the company. Ridiculous. I'm just saying a guy busted for alcohol knew he was getting 4 or 6 weeks off at 95% pay, the guy with cancer didn't know what to expect.

Alcoholism is the only disease I know people brag about having. I'm not saying it is or isn't, but if it is they really need a better way of diagnosing it because a lot of people are faking it or using it as an excuse.

Wow! Canada really is progressive. Instead of dealing with all the usual stigma, the alcoholics can actually brag about their condition.

Here in America, alcoholism is often covered up. Because we don't have Canada's acceptance, a person is more apt to hide the fact that they have a problem. If they work in an industry where intoxication can be a danger to themselves and others, they won't get the treatment they need because they worry about being fired. This could lead to a work place accident that harms them or a co-worker.

A Canadian company may have to hold a person's job while they get treatment but the few weeks of near full pay are far cheaper than long-term reduced productivity, an industrial accident, or a lawsuit.

But what is the net result of this liberal attitude when compared to the shame and blame stance of the US? First off, Canadians drink less per capita. Approximately 4% of Canadians vs 6% of Americans are alcoholics. In the last 5 years there has been an overall decline in drinking in general among both adults and teens. There is also a decrease in harm related to drinking.

 

[xjx388]

No it isn't. As far as I know the criteria for an addiction being considered a disease is only met by opioid addiction. Alcohol addiction or dependence is considered clinically as a disorder according to the DSM.

I haven't read the entire thread so my apologies if this has been discussed. You seem to subscribe to the disease model which clearly isn't universally accepted, and is the minority view.

It's not a minority view in the medical community.

 

[Marcus]

...But what is the net result of this liberal attitude when compared to the shame and blame stance of the US? First off, Canadians drink less per capita. Approximately 4% of Canadians vs 6% of Americans are alcoholics. In the last 5 years there has been an overall decline in drinking in general among both adults and teens. There is also a decrease in harm related to drinking.

Correlation does not equal causation.

Cite me proof that the disease model of addiction has led to a worsening of the problem of addiction.

I don't know if proof is available, but the logical chain is easy enough to follow, as illustrated by 3bodyproblem's anecdote. The idea that alcoholism is a disease provides the perfect excuse to evade any responsibility, not only for alcoholics, but for people who are not alcoholics.

 

[MikeSun5]

Could you cite that?

Not sure where you get this.

As I've linked to and explained numerous times already, alcoholism receives funding SEPARATE from other addictions. Most other addictions must share funding with other disorders as they are lumped into different non-disease categories. Based on that chart, I wonder how much money the NIH devotes to the "disease" we call a gambling addiction. Maybe some funding going towards "Mental Health" is used to research and treat it, but not nearly as much as alcohol. That's my point.

If someone is watching porn to an extent that it interferes with their life, then yeah, I would say they are diseased. But maybe not quite in the same way an alcoholic is. Separate discussion.

If you claim alcoholism is a disease, it's not a separate discussion at all.

You say a person who has an unhealthy addiction to porn has a disease. I disagree 100%, but I applaud you for being the first person to be consistent with their definitions.

 

[Dancing David]

As I've linked to and explained numerous times already, alcoholism receives funding SEPARATE from other addictions.

Um, not in any treatment settings that I know of, i asked for your citation, I am asking out of interest, not argument. The state of Illinois has DASA or whatever they call it now, there is one pool to treat substance abuse period.

So i am just curious. You have explained , I am looking for the citations of this information so I can read them.

ETA: Your link is to funded research, am I correct?

Or is it to funded treatment? I may have mis-read it.

 

[Dancing David]

MikeSun5, you do know that in the DSM and the ICD alcohol is a subset of substance dependence/abuse ?