Addiction is a disease

[SirPhilip]

How do obsessive-compulsive disorders fit into your scheme of things?

I suppose by asserting alcoholism has to be a result of attachment to a milk bottle during infancy, you could also counter that your experience with Irish people contradict this, and we could go around in circles for five pages. Seriously, if it's simply an obsessive compulsive behavior - the act of drinking something, why not something healthy? Alcohol, as hard drugs go, is like smashing yourself over the head. Only the social phobic or those with serious a reason to not deal with something make drinking a part of their daily lives..

 

[Skeptic Ginger]

I know that this is a sceptics forum but is two months without alcohol an extended period?

At this time the one friend i am think of has not had a large amount of alcohol since December. And he does not have any of the functioning problems associated with alchol. When he is drinking it is normaly a drink or two a couple times a week. But when he is socializing with people who drink heavily then he drinks very heavily. The incident i mentioned was an example that happened about six yeras ago when he had neighbor friends who were periodic heavy drinkers as well. His current heavy use is about eight drinks.

And you just have to take my word, there is no impairment in his daily functioning.

Believe me, I know what that is about, the individual I am thinking of is very functional, the periods of heavy drinking come mainly from the social area he is in.


I am not sure which three you are referencing, I personaly use behavioral criteria for addiction (although i have not done assesment since changing jobs seven months ago.)

We could go round all day on this. You now added that one of these bingers drinks a couple times a week whereas earlier, it was "they go for extended periods without any use or overuse of alcohol". Even that statement, use or overuse is a contradiction.

People who drink a lot consistently underestimate how much they drink. People who drink a lot and recognize it to some degree, commonly hide some of their drinking. People who drink a lot or who are friends/family of alcoholics underestimate how much the drinker consumes.

I cannot say what is the situation with the people you are describing. So let's discuss the indicators of disease, patterns of use and the issue of denial and underestimating consumption both by the drinker and by those around them.

Diagnosis:

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)

DSM-IV: Substance Abuse criteria

A pattern of substance use leading to significant impairment in functioning. One of the following must be present within a 12 month period: (1) recurrent use resulting in a failure to fulfill major obligations at work, school, or home; (2) recurrent use in situations which are physically hazardous (e.g., driving while intoxicated); (3) legal problems resulting from recurrent use; or (4) continued use despite significant social or interpersonal problems caused by the substance use. The symptoms do not meet the criteria for substance dependence as abuse is a part of this disorder.

DSM-IV: Substance Dependence criteria

Substance use history which includes the following: (1) substance abuse (see above); (2) continuation of use despite related problems; (3) increase in tolerance (more of the drug is needed to achieve the same effect); and (4) withdrawal symptoms.

Alcohol Use Disorders Identification Test (AUDIT)

Drug Abuse Screening Test (DAST)

Prevalence of abuse and dependence including a bar graph showing 1 or more DUIs does indeed predict abuse and dependence. See figure 7 (since I brought that issue up earlier.)

The U.S. national average for alcohol dependence is 4.4% with males at 6.3% and females at 2.6% (NIAAA, 1994) [9]. This increases to 9.7% for “current drinkers” [10] (Males = 11.3%, Females = 7.6%). Overall, the national average for females is about half that of males. However, females (11.1%) had about the same rate of dependence as males (12.3%)

So my 10% figure was about right if you exclude non-drinkers.

You can have abuse without dependence and rarely, dependence without abuse. See figure 8


Denial and under-reporting of amount of alcohol intake:
The Denial and Awareness Scale (DAS)

"Furthermore, one of the key facets of addictive behavior is denial, not only by the addict, but by the family as well....The denial process starts gradually and occurs as the family begins to compensate for the substance abuser."

The under-reporting of alcohol use: the role of organic mental syndromes.

"Denial of alcoholism is a serious obstacle to the successful treatment of an alcoholic. If clinicians can conceptualize and focus on this denial, they may be able to make more effective interventions with alcoholics. Denial in alcoholism, as in other illnesses such as cancer and heart disease, may encompass denial of the entire illness or only denial of some aspect, such as the loss of control over alcohol consumption."


Patterns of drinking and clinical course of alcoholism:

"Periods of abstinence following the onset of alcohol dependence in 1,853 men and women...Data from both laboratory experiments and retrospective histories of alcoholics indicate that alternations between periods of abstinence and heavy drinking are common in the course of alcoholism. This article examines the prevalence, chronological characteristics and clinical features associated with periods of abstinence in a large sample of alcohol dependent men and women."

The clinical course of alcoholism in 243 Mission Indians.

Drinking course in alcohol-dependent men from adolescence to midlife.

WHO/ISBRA Study on State and Trait Markers of Alcohol Use and Dependence:

analysis of demographic, behavioral, physiologic, and drinking variables that contribute to dependence and seeking treatment. International Society on Biomedical Research on Alcoholism....alcohol-dependent subjects consumed more alcohol than nondependent subjects, alcohol consumption increased with age...the category designated as heavy drinkers (>210 g alcohol/week)...although men drank more than women on a g/day basis, the differences were less pronounced on g/kg/day basis, and alcohol-dependent women drank equal amounts of alcohol as alcohol-dependent men on a g/kg/day basis. Antisocial personality characteristics or reports of trouble sleeping when an individual stops drinking were associated with higher alcohol intake. The most important of the tested factors that contributed to a DSM-IV diagnosis of dependence, however, was the report of anxiety if an individual stopped drinking. In terms of the various criteria within the DSM-IV criteria for alcohol dependence, no one criterion seemed to be prominent for individuals who sought alcohol dependence treatment, but the higher the number of criteria met by the individual, the higher was the probability that he or she would be in treatment.

The 5-year clinical course of high-functioning men with DSM-IV alcohol abuse or dependence

....This study evaluated the ability of the DSM-IV categories of alcohol abuse and alcohol dependence to predict the onset and cessation of the 11 DSM-IV abuse/dependence criterion items. METHOD: The DSM-IV categorical approach was used to determine alcohol diagnoses for 435 highly educated young adult men, who constituted 97.3% of the 447 men appropriate for this study. Structured face-to-face follow-up interviews were administered 5 years later. RESULTS: At the beginning of the study, 14.5% (N=63) of the subjects were alcohol dependent, 18.2% (N=79) reported alcohol abuse, and 67.4% (N=293) carried no alcohol diagnosis. Across these three diagnostic groups, 68.3%, 46.8%, and 15.4%, respectively, experienced at least one of the 11 DSM-IV abuse/dependence criterion items over the next 5 years. Only 11.4% of those who reported alcohol abuse went on to develop alcohol dependence. In addition to their diagnosis, characteristics that predicted subsequent problems with alcohol included a family history of alcoholism, higher levels of alcohol intake and a greater number of alcohol problems in the 10 years preceding the diagnosis, and a history of drug use. CONCLUSIONS: Even in this highly educated and high-functioning group of men, alcohol abuse and dependence predicted the onset and cessation of alcohol-related problems.

Patterns of DSM-IV Alcohol Abuse and Dependence Criteria Among Adolescents and Adults: Results From the 2001 National Household Survey on Drug Abuse

...Overall, the most prevalent criteria of DSM-IV alcohol dependence were "tolerance" and "time spent obtaining alcohol, drinking, or getting over its effects." The most prevalent criterion of DSM-IV alcohol abuse was "hazardous use." The prevalence of alcohol abuse only and of dependence with and without abuse was highest among respondents aged 18-23 years, followed by respondents aged 12-17 years, and lowest among respondents aged 50 years and older....Conclusions:

The higher prevalence for some dependence criteria among adolescents and young adults as measured in the present study may blur the distinction between symptom reports associated with the normative development of drinking patterns and clinically relevant aspects of DSM-IV alcohol dependence.

So, the patterns of drinking you describe can occur in younger men but if they continue for the decades as you describe, it is extremely unlikely to be in the absence of dependence or abuse or both. It's much more likely you are underestimating how much these guys are drinking in between heavy drinking. And with the amount you are describing in the heavy drinking, tolerance is clearly involved.

Take a look at figure 10 in this citation I noted earlier. The higher you get your blood alcohol in a drinking binge, the more likely you are to be dependent.

 

[Skeptic Ginger]

So if I get hooked on green tea, do I have a disease too? But my question is, what lacking in someone's physiology would alcohol abuse salve, rendering it's abuse somehow justified outside the obvious?

You are still tagging disease with "justified". They are not married.

A diabetic or an epileptic can irresponsibly willfully and knowingly drive a vehicle when their disease is not well controlled. Either can cause a serious accident if they have an insulin reaction or a seizure respectively while driving. They have a disease but it doesn't absolve them of responsibility for their behavior.

Various mental disorders affect behavior. That doesn't make the disorders less of a disease.

In drug abuse/dependence you have a mix of disease elements, behavior elements and according to our societal norms which I agree with, you have responsibility elements.

What is the usefulness of placing alcoholism in the disease category? Because it is treatable. And because treating the person for their addiction results in fewer re-offenses and probably is more cost effective that just locking people up again and again. An addiction makes it very hard for that person to act responsibly. Helping them makes sense for everyone involved, especially the person they might kill the next time they drive drunk.

 

[Skeptic Ginger]

I suppose by asserting alcoholism has to be a result of attachment to a milk bottle during infancy, you could also counter that your experience with Irish people contradict this, and we could go around in circles for five pages. Seriously, if it's simply an obsessive compulsive behavior - the act of drinking something, why not something healthy? Alcohol, as hard drugs go, is like smashing yourself over the head. Only the social phobic or those with serious a reason to not deal with something make drinking a part of their daily lives..

This example and the green tea example are not valid analogies.

 

[athon]

So if I get hooked on green tea, do I have a disease too?

Is the influence of your biology to drink green tea outside of the normal? Can this influence have a negative impact on your wellbeing? If 'yes' to both of these, then it fits the definition of a disease.

Why is that so difficult for you to grasp?

But my question is, what lacking in someone's physiology would alcohol abuse salve, rendering it's abuse somehow justified outside the obvious?

What are you meaning by 'justified'? Justification has nothing to do with it. It's a condition of one's biology that is a) outside of the norm, and b) detrimental to well being. If my neurophysiology influences me to be overly abusive, I have a responsibility to address this. By definition it's a disease, but this does not absolve me of the need to keep it in check.

Just to recap the positions;

A) Addiction is not a disease

B) Yes it is. A disease is 'insert definition', and 'insert reasons' is why it is one.

A) No it's not.

B) Fine; then what is your definition and reasoning?

A) Addiction is not a disease. It just isn't. I know it just like I know anything.

B) Then what is a disease?

A) um.... Addiction is not a disease.

B) *sigh*



Athon

 

[Taffer]

Not alcoholism.

So you do not have a definition of "disease"? A definition is not a negate of something else, otherwise you are saying "anything which is not alcoholism is a disease".

You really need to think your opinions through.

 

[Taffer]

"Emotional response"? I have no emotional stock in whether or not "alcoholism" is a disease. It's irrelevant to me. I simply know it isn't. Like I know the sun is bright and 2+2=4.

Ah yes, just like you 'know' that anyone who fantasizes about rape is going to become a rapist, dispite the fact that reality does not reflect this. And just how you 'know' morals are objective, despite the fact that reality does not reflect this.

Tell me, do you 'know' anything which reality does reflect?

Also, "2+2=4" is not knowledge, any more then saying "bachelors are unmarried men" is. At least, it is not objective knowledge.

 

[Taffer]

How many more fallacious one liners do you have left?

How many fallacies are you going to commit?

 

[Taffer]

FWIW, I do not consider addiction a disease, I consider it a disorder. To me, a disease is caused by an infectious agent, and I'm not sure that addiction is caused by a meme.

 

[Skeptic Ginger]

FWIW, I do not consider addiction a disease, I consider it a disorder. To me, a disease is caused by an infectious agent, and I'm not sure that addiction is caused by a meme.

Is cancer a disease or a disorder? How about cystic fibrosis? Heart disease? Diabetes?

 

[Taffer]

Is cancer a disease or a disorder? How about cystic fibrosis? Heart disease? Diabetes?

IMHO, they are all disorders. None are caused by infectious agents, but rather, at their root, caused by genetics.

ETA: Or syndromes. Which are different things. My point is that none of the above are diseases, as I consider diseases caused by infectious agents.

 

[Skeptic Ginger]

Where do you find a definition of disease that says it is limited to infections? Those are called infections, infectious diseases, and communicable diseases.

Web definition of disease. None of them match your version.

 

[Taffer]

Where do you find a definition of disease that says it is limited to infections?

{snip}

Web definition of disease. None of them match your version.

If we wish to play with definitions...

The term 'disease' refers to any abnormal condition of an organism that impairs function. This causes discomfort, dysfunction, distress, or death to the person afflicted or those in contact with the person. Sometimes the term is used broadly to include injuries, disabilities, disorders, syndromes, infections, symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories. In the narrow sense, a disease is the invasion of the body by pathogens.

Bolding mine. From wiki.

But does it really matter? It's just semantics. Even if we all agree with your definition of disease, how does that change the problem of addictions? Why does it matter if we call an addiction a disease, a syndrome, or anything else?

Those are called infections, infectious diseases, and communicable diseases.

Nope. Infections is what happens when you are infected by a bactera. For example, you have a bacterial infection. But a bacterial infection is what causes the disease of pneumonia, for example. An infectious disease and a communicable disease are diseases which can be transmitted to other people.

But again, these are just labels. This is how these words have been used through my studies. Using a different word does not take away from the substance of what things are, it just gives that substance a different label.

ETA: Some of the definitions given in your link actually do agree with me. Some do not. This is why arguing from definition is fallicious. If you disagree with my argument, do not disagree with the words, disagree with the substance.

• A condition of an organic being or of one of its parts that impairs normal living functioning.
• An abnormal condition of a plant in which its physiology, morphology, and/or development is altered under the continuous influence of a pathogen. (3)
• can be defined as a derangement in the function of the whole body of the host or any of its parts.
• a condition, caused by living organisms or environmental changes, that impairs the normal functions of a living organism.
• A condition of being sick from a particular cause. Different plants and animals often suffer from certain diseases. Some animals are known to carry diseases that effect other organisms. For example, a beetle carries a fungus which causes Dutch Elm Disease in elm trees.
• A morbid entity characterized usually by at least two of these criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomical alterations.

 

[Skeptic Ginger]

Taffer, no one is "playing with definitions". You may define disease any way you wish. Very few people, if any besides yourself, use such a narrow definition of disease.

And I do believe my posts reflect the same sentiment, it's what you do with the way you define alcoholism that matters not the name you give it. You treat a disease. A disease does not absolve you of responsibility.

 

[Taffer]

Taffer, no one is "playing with definitions". You may define disease any way you wish. Very few people, if any besides yourself, use such a narrow definition of disease.

Ok then, I guess none of my professors used it that way, either, during my medical genetics lectures.

And I do believe my posts reflect the same sentiment, it's what you do with the way you define alcoholism that matters not the name you give it. You treat a disease. A disease does not absolve you of responsibility.

I never said it does, did I? I said "I do not consider addiction a disease, I consider it a disorder. To me, a disease is caused by an infectious agent, and I'm not sure that addiction is caused by a meme.". Does that, in any way, suggest that I think people are absolved of responsibility? Does it say that people are completely responsible? No. It simply says I would not call it a disease, re: the OP. Please don't jump to conclusions about my view point on alcoholism, as I have not stated it yet.

 

[athon]

Also, "2+2=4" is not knowledge, any more then saying "bachelors are unmarried men" is. At least, it is not objective knowledge.

Actually, it's a mathematic axiom, or self-evident truth, rather than an objective observation. It's commonly used by people who try to describe things as self evident, when they are anything but. Or by those who cannot articulate their reasons for believing something.

Athon

 

[athon]

If we wish to play with definitions...

Quote:
The term 'disease' refers to any abnormal condition of an organism that impairs function. This causes discomfort, dysfunction, distress, or death to the person afflicted or those in contact with the person. Sometimes the term is used broadly to include injuries, disabilities, disorders, syndromes, infections, symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories. In the narrow sense, a disease is the invasion of the body by pathogens.
Bolding mine. From wiki.

Wiki? Where did they get that definition from? I know wiki is useful, but seriously, this feels like somebody's personal take on the concept rather than the accepted definition. I've never, ever seen in a text book a definition narrowed down to requiring a pathogen.

But does it really matter? It's just semantics. Even if we all agree with your definition of disease, how does that change the problem of addictions? Why does it matter if we call an addiction a disease, a syndrome, or anything else?

You're dead right. It is semantics. The reality is, calling it a disease or disorder has little signficance in isolation from a greater context. I have no problem with somebody calling addiction a disorder; it's the vehement objection to calling it a disease. The problem here is when individuals cannot accept that addictions are biological influences. This says nothing of responsibility or justification, but does indicate that addiction has consequences beyond being a normal choice that we all face.

But again, these are just labels. This is how these words have been used through my studies. Using a different word does not take away from the substance of what things are, it just gives that substance a different label.

Labels connote different meanings, though. As we see here, a label has significance. Or you wouldn't get such posts which strongly state that addiction is not a disease.

A condition of an organic being or of one of its parts that impairs normal living functioning.
An abnormal condition of a plant in which its physiology, morphology, and/or development is altered under the continuous influence of a pathogen. (3)
can be defined as a derangement in the function of the whole body of the host or any of its parts.
a condition, caused by living organisms or environmental changes, that impairs the normal functions of a living organism.
A condition of being sick from a particular cause. Different plants and animals often suffer from certain diseases. Some animals are known to carry diseases that effect other organisms. For example, a beetle carries a fungus which causes Dutch Elm Disease in elm trees.
A morbid entity characterized usually by at least two of these criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomical alterations.

How is this not indicative of addiction being a disease? Especially the first one.

Athon

 

[Taffer]

Actually, it's a mathematic axiom, or self-evident truth, rather than an objective observation. It's commonly used by people who try to describe things as self evident, when they are anything but. Or by those who cannot articulate their reasons for believing something.

Athon

Agreed. And you're quite correct, I was over simplifying. That was the reason for my "objective knowledge" at the end of it.

 

[Taffer]

Ok, I'll bite; difference between a disorder and a disease? And I don't mean your personal take on the connotation of each. I mean; what is the pathologically accepted definition of each. And why is an addiction a disorder, and not a disease?

Athon

Since I am not a med student, I can't give you a "pathologically accepted definition". To be clear, I have stated from the start that it is "what I think", not what science at large might think.

That being said, I personally define the difference between "disease" and "disorder" as the former being caused by an infectious agent, and the latter is caused by a genetic 'fault', or through the interaction between a genetic 'fault' and the environment.

Please note that this is just the way I define the words, based on university classes such as my medical genetics paper. It might not be the majority opinion. But does that really matter? I have define my words, and then made my claim. Do you disagree with my use of the terms, with my claim in light of these definitions, or with the claim in general? If it is the first, provide your own definition and I will re-evaluate my claim in light of these definitions.

 

[Taffer]

Wiki? Where did they get that definition from? I know wiki is useful, but seriously, this feels like somebody's personal take on the concept rather than the accepted definition. I've never, ever seen in a text book a definition narrowed down to requiring a pathogen.

Fine, my definition is wrong. Does it really matter? If I use the words without explaining what they mean, then perhaps, but I did not. I explicity defined my terms, so there should be no problem.

You're dead right. It is semantics. The reality is, calling it a disease or disorder has little signficance in isolation from a greater context. I have no problem with somebody calling addiction a disorder; it's the vehement objection to calling it a disease. The problem here is when individuals cannot accept that addictions are biological influences. This says nothing of responsibility or justification, but does indicate that addiction has consequences beyond being a normal choice that we all face.

I have made no claim as to whether I think addiction has a biological basis, nor any claim as to the responsibilities of those who suffer from addiction. I have only stated what I would call it, and why.

Labels connote different meanings, though. As we see here, a label has significance. Or you wouldn't get such posts which strongly state that addiction is not a disease.

They only matter if the definitions have not been defined. If one uses a label, and does not explain why nor defines their definitions, then all is open to interpretation. Honestly, I don't understand people's problem with my original post. I explained that I would call it a disorder and not a disease, and explained why. I made no claim of the nature of addiction.

How is this not indicative of addiction being a disease? Especially the first one.

Athon

Depends on how you define disease, doesn't it? As I said before, fine, I will drop my definition, as it seems to cause many problems. In that case, I would call addiction a disease, as now "disease" includes things which have a genetic component.

ETA: I guess now I have made the claim that addiction has a biological component.