Addiction is a disease

skeptigirl said:
I don't understand this post but as to your one above, the brain is an organ and can malfunction. If a virus infects your brain or you have a fever and hallucinate, there is no question it is a disease. Alcoholism has some qualities we characterize as behavioral and some we characterize as disease. Read the previous posts.
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Alcoholism doesn't strike me as a proper disease though. Even if it's separated form 'dis ease' sort of hits two nails on the head: the dis-ease which is the catalyst for drinking, and the dis-ease that results from long term consumption of it. Or conversely, ease. The ease with which to forget, or have an unforgettable night for that matter. People associate the word disease with a medical affliction that is out of their control, not substance abuse, which overwhelmingly is due to psychological dependence.

In this sense, 'disease' would apply to opioid/opiate addiction far better.
 
athon said:
Mate, I'm hardly heated over this, but it is frustrating having people make claims with their own variations on a definition. Arguments, which could otherwise be productive, become nothing more than battles of semantics.



A truly arrogant statement if ever there was one. I point out that definitions need to be clear if you are to argue a term, and you state that you don't need to be told how to use language? Well, could have fooled me.



No, a waste of time is when people make bold statements without defining what they mean by them. It's like somebody stating they are gay because they once kissed their uncle on the cheek. Sure, they might have their own definition of gay, but if it doesn't suit everybody else's, confusion arises.

As here. You state clearly that it isn't a disease. Fine. Define disease. If you're really are more concerned about the 'how' rather than the definition, then why are you so adamant that it isn't a disease?





Short memory?

Athon
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I like the defintion of disease as you have presented it, and it is a nice clear one. I did not mean that you were a strident one, although i did not make that clear.

However in common usage the disease concept is one of a number of different things
-an infection of some sort
-a 'malfunction' or 'not functioning' as intended in a biological system
-impairment in functioning or decrease in functioning in a biological system
-a function in the system that has detriment to the health of the organism.

All of which fit in with the very nice definition that you have offered.

However when it comes to alcoholism I know some of the following into the definition you have offered:
-mental illness that people seek to self medicate
-the detrimental effects of the use of a substance
-those with OCD who use as part of the OCD


(Edited to add and to try to explain my thinking around your defintion )

Posted by Athon pg1 of this thread
I've seen more definitions for the word 'disease' then you can poke a stick at. But for the most part, they all have a central point;

A disease is an impeding deviation in the normal functioning of an organism.

'Normal functioning' is always the sticking point; all organisms vary, and the extent to which this variation impedes their wellbeing or way of life can be rather open to debate. Yet diseases are always an alteration of the normal functioning, which is a good place to start with exploring whether something is a disease or not.

The question is; could your functioning be said to be affected which results in an addiction? The straight forward answer is 'yes'. Now, are all addictions perversions of normal functioning? I would argue again 'yes', only on the grounds that the mind and our behaviour have no non-material part, therefore can only result from neural functioning. If this fails, even if from lack of will power, determination or desire, I would define that as a failure in function.

The problem arises because we associate pity with disease, as if we can seperate functioning from desire. If somebody is sick, it's not their fault. I can't make that association with the term 'disease' by any stretch of the definition. Therefore, whether they have control or not, it remains a disease if their functioning is impeded in some manner.
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My disagreement would be on what constitutes a deviation in normal functioning when it comes to behavior, I think you will note that I have stated there is a biological basis to human behavior and i am a strcit materialist.

There are those who are driven to addiction through the biology of thier system, but as a behavioralist who agrees that we are solely biological mechanisms. I do not believe that behavior is soley deterministic, i do believe that there is aan element of perhaps constrained choice in the system. So while I agree that behaviors can lead to deviations in the biological norm of the system, i also believe that there are things in behavior that are not determined solely by the functioning of the system

In short (because I have to leave for work and I am sure this is not the clearest i can state my unorganised thinking at this time) there are things that are behavioral that are driven by the biological system (mental illness such as schizophrenia) and there are those that are driven by choices made in the cognition and actions of the biological entity. So while I agree that behaviors can lead to disease , the oft cited diabetic with poor diet, I think that there are those behaviors which lead to a deviated biological function that are not driven by just the functioning of the system.. I don't know how to keep that from becomeing a free will argumement.

And certainly that is a circular mess of defintions i made that will need revising and modification and through examination probably toatl renovation.
 
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skeptigirl said:
If you are 21 getting too drunk at a frat party more often than you should but when the time comes to be serious you grow out of it then I agree with you. Youthful indiscretion as they say, there's a learning curve involved. But when I was that age there were still some people who enjoyed getting drunk more than they enjoyed the party. Some of them stood out. Of those a good number of them were alcoholics in the making.

I'm not sure of the stats and don't want to hunt down a reliable source but I recall the rate of alcoholism is about 10% of the adult population if you use a low threshold definition. By all means if someone knows the correct %, post it for us. I'd guess in college or around that age, a lot of people drank more than later in their lives, and more than a few got drunk once or twice. But I would bet not a lot more than 10% got 'really drunk once a week or more'. And of those that did get really drunk often most of them did indeed have a problem. How many of those people self arrested their drinking when the social climate changed from party time to work/family time or how many went on to develop full blown alcoholism I have no statistics on. I can say people who drink a lot over estimate how many other people drink as much as they do.

So when you say, "many people consume large amounts of alcohol and are not alcoholics", you really have to quantify the time frame this goes on for. The majority of people in this culture (USA) who drink, do not do so to the point of intoxication very often throughout their lives. Maybe during that age of enlightenment, but certainly not much after that. For one, the partying stops at some point and other people do not enjoy being around a drunk. Right then you have a problem.
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As I said before I have friends who on a regular basis consume way to much alcohol. Like a very large amount over an evening, say the equivalent of twenty ounces of grain alcohol over an evening (have three beers, go out and have three glasses of wine, then return for beer (three), then go next door and have two mixed drinks (4-6 shots) and then have four glasses of champagne. Or just drink a lot of mixed drinks.

But they seem to function the rest of the time, they go for extended periods without any use or overuse of alcohol. Some have done it for ten years , others for thirty, one for fifty.
 
SirPhilip said:
Alcoholism doesn't strike me as a proper disease though. Even if it's separated form 'dis ease' sort of hits two nails on the head: the dis-ease which is the catalyst for drinking, and the dis-ease that results from long term consumption of it. Or conversely, ease. The ease with which to forget, or have an unforgettable night for that matter. People associate the word disease with a medical affliction that is out of their control, not substance abuse, which overwhelmingly is due to psychological dependence.

In this sense, 'disease' would apply to opioid/opiate addiction far better.
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How do obsessive-compulsive disorders fit into your scheme of things? Which psychological disorders do you consider a disease and which are not? What defines the difference in brain function?

The "out of their control" is the association applied to disease which I, as a medical professional, do not apply.
 
Dancing David said:
As I said before I have friends who on a regular basis consume way to much alcohol. Like a very large amount over an evening, say the equivalent of twenty ounces of grain alcohol over an evening (have three beers, go out and have three glasses of wine, then return for beer (three), then go next door and have two mixed drinks (4-6 shots) and then have four glasses of champagne. Or just drink a lot of mixed drinks.

But they seem to function the rest of the time, they go for extended periods without any use or overuse of alcohol. Some have done it for ten years , others for thirty, one for fifty.
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If your description is accurate, you underestimate their dependence and at least their physical consequences of consuming that much alcohol. The liver can take an incredible amount of damage before full blown cirrhosis or alcoholic hepatitis from fatty liver manifests symptoms. I have doubts about that "extended period" of time between. They may just drink less in between binges, I doubt they don't drink at all.

The exception are people who have jobs where alcohol is not available such as fishermen. They may go out for a couple months on a boat where no alcohol is available and drink when on land. Forced abstinence is possible for many alcoholics and for all when you lock them up. But they relapse when the option presents itself.

"Seeming to function" is common in alcoholism as is denial.

Re your disease definition:
-a 'malfunction' or 'not functioning' as intended in a biological system
-impairment in functioning or decrease in functioning in a biological system
-a function in the system that has detriment to the health of the organism.
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All three of these apply to alcoholism without having an accompanying disorder such as self medicating depression.
 
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Dustin said:
"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.
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And with that, Dustin's credibility completely died.

Thanks for playing, sunshine. Seriously, science just isn't your strong area.

Athon
 
Dancing David said:
I like the defintion of disease as you have presented it, and it is a nice clear one. I did not mean that you were a strident one, although i did not make that clear.

However in common usage the disease concept is one of a number of different things
-an infection of some sort
-a 'malfunction' or 'not functioning' as intended in a biological system
-impairment in functioning or decrease in functioning in a biological system
-a function in the system that has detriment to the health of the organism.
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You are correct. Common usage indeed conotes these things; I would go further to suggest that in general vernacular, 'disease' also carries an implication of being contagious, hence the common application of the term 'to catch' when it comes to acquiring a disease.

The point is, the term disease as used in pathology has a rather broad definition. You can point out 'common definition' for a term, but in science we avoid such connotative language in the name of limiting ambiguity.

My disagreement would be on what constitutes a deviation in normal functioning when it comes to behavior, I think you will note that I have stated there is a biological basis to human behavior and i am a strcit materialist.
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Of course, this is always a sticking point when it comes to describing something as a disorder or disease. 'Normal' functioning is not a strictly contained point, but rather a spectrum, and defining where the boundaries lie is rather arbitrary. I also believe that behaviour is a biological function (it can't really be anything else) that relies on the interactions of our biochemical and nervous systems. Variation in this produces variation in behaviour.

So, is an addiction outside of 'normal' functioning? If normal is defined as a set of characteristics as expressed by a majority of a population, then I would argue that addiction is abnormal. More people are not addicted to alcohol, in that it influences their decisions and behaviour, than are.

The second part of the definition - where this variation impedes well being - can inarguably be applied to alcoholism. The wellbeing and sense of satisfaction that addicts have with their lives, as a result of the variation in function, is reduced due to the influence of their behaviour.

There are those who are driven to addiction through the biology of thier system, but as a behavioralist who agrees that we are solely biological mechanisms. I do not believe that behavior is soley deterministic, i do believe that there is aan element of perhaps constrained choice in the system. So while I agree that behaviors can lead to deviations in the biological norm of the system, i also believe that there are things in behavior that are not determined solely by the functioning of the system
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Which is at the crux of your argument. And fair enough, too. I personally cannot abide by any ghost in the machine; all behaviour - free will or otherwise - is controlled by biological functioning. If the variation in my thinking, influenced by past experiences, environment, neural structure, genetics...whatever... deviates greatly from the norm and reduces my sense of wellbeing, it fits the definition of disease.

Indeed, if you do not consider thinking or behaviour to be the result of biological function (which I can't see how it isn't), then the term disease will not suit addiction. However, it would also not suit many, if any, other psychological conditions.

Therefore, how would one draw a line between, say, schizophrenia (which is commonly accepted as a mental disease) and addiction?

In short (because I have to leave for work and I am sure this is not the clearest i can state my unorganised thinking at this time) there are things that are behavioral that are driven by the biological system (mental illness such as schizophrenia) and there are those that are driven by choices made in the cognition and actions of the biological entity. So while I agree that behaviors can lead to disease , the oft cited diabetic with poor diet, I think that there are those behaviors which lead to a deviated biological function that are not driven by just the functioning of the system.. I don't know how to keep that from becomeing a free will argumement.

And certainly that is a circular mess of defintions i made that will need revising and modification and through examination probably toatl renovation.
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Of course. Thank you for taking the time to explain what you mean so carefully. It does make a difference, and rather than quibbling back and forth over 'it is / isn't a disease', we can see the real crux of where we disagree; that cognition and choice of actions in a biological entity either is or is not (depending on our respective stances) the direct result of biological functioning.

Athon
 
Dustin said:
How many more fallacious one liners do you have left?
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One for every bit of nonsense you can produce.

Now, are you going to play like a grown up or continue to sulk? David, who is also on your 'not a disease' side, has managed to express quite a good explanation of his reasoning. If you're not up to that level of expression, then I guess I expect more winkies and witless retorts from you.

Athon
 
athon said:
One for every bit of nonsense you can produce.

Now, are you going to play like a grown up or continue to sulk? David, who is also on your 'not a disease' side, has managed to express quite a good explanation of his reasoning. If you're not up to that level of expression, then I guess I expect more winkies and witless retorts from you.

Athon
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So let David waste his time arguing with you. I have better things to do.
 
skeptigirl said:
If your description is accurate, you underestimate their dependence and at least their physical consequences of consuming that much alcohol. The liver can take an incredible amount of damage before full blown cirrhosis or alcoholic hepatitis from fatty liver manifests symptoms. I have doubts about that "extended period" of time between. They may just drink less in between binges, I doubt they don't drink at all.
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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.
The exception are people who have jobs where alcohol is not available such as fishermen. They may go out for a couple months on a boat where no alcohol is available and drink when on land. Forced abstinence is possible for many alcoholics and for all when you lock them up. But they relapse when the option presents itself.

"Seeming to function" is common in alcoholism as is denial.
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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.
Re your disease definition:All three of these apply to alcoholism without having an accompanying disorder such as self medicating depression.
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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.)
 
athon said:
You are correct. Common usage indeed conotes these things; I would go further to suggest that in general vernacular, 'disease' also carries an implication of being contagious, hence the common application of the term 'to catch' when it comes to acquiring a disease.

The point is, the term disease as used in pathology has a rather broad definition. You can point out 'common definition' for a term, but in science we avoid such connotative language in the name of limiting ambiguity.
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Definite agreement there, yet on this board the debates are numerous over termionology. Defintion is crucial in self referencing communications.
Of course, this is always a sticking point when it comes to describing something as a disorder or disease. 'Normal' functioning is not a strictly contained point, but rather a spectrum, and defining where the boundaries lie is rather arbitrary. I also believe that behaviour is a biological function (it can't really be anything else) that relies on the interactions of our biochemical and nervous systems. Variation in this produces variation in behaviour.
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In the common practice of assesment of DSM based judgements there is defintily too much personal judgement in assesment and also alot of guessing and trained guessing. I have my set of criteria that i use and it is mostly experience based.

Where one might see adjustment disorder another will see major depression.

Some day i am sure the DSM will be more definitive but it is a tool to assist in communication, not like the color charts used by people trying to define colors.

And yes I too believe that we are biomechanical mechanisms.
So, is an addiction outside of 'normal' functioning? If normal is defined as a set of characteristics as expressed by a majority of a population,
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well there is a sticking point for sure, most people are in denial of other people's addictions.
then I would argue that addiction is abnormal. More people are not addicted to alcohol, in that it influences their decisions and behaviour, than are.

The second part of the definition - where this variation impedes well being - can inarguably be applied to alcoholism. The wellbeing and sense of satisfaction that addicts have with their lives, as a result of the variation in function, is reduced due to the influence of their behaviour.
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Which also is part of the self medication issue as well.
Which is at the crux of your argument. And fair enough, too. I personally cannot abide by any ghost in the machine; all behaviour - free will or otherwise - is controlled by biological functioning. If the variation in my thinking, influenced by past experiences, environment, neural structure, genetics...whatever... deviates greatly from the norm and reduces my sense of wellbeing, it fits the definition of disease.
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My thinking is that we have a multivalue spectrum in the behaviors and the influence of biology in the making of choices.

My thinking is that there is a segment of addicted people who have 'usual functioning' when they become addicts but they have serious addicted thinking that becomes the basis of thier addiction. And then of course there are serious biological and life issues from mopst addictions that fuel the addiction further. So the orgins matbe strictly behavioral but the progressed state of anb addiction has a heavily biological consequence that is likely to be viwed as a disease by many. (Even the solely behavioral mood altering disorder have a heavy biological consequence.)
Indeed, if you do not consider thinking or behaviour to be the result of biological function (which I can't see how it isn't), then the term disease will not suit addiction. However, it would also not suit many, if any, other psychological conditions.

Therefore, how would one draw a line between, say, schizophrenia (which is commonly accepted as a mental disease) and addiction?
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In schizophrenia there are distortion in thinking in the abcense of a substance and after a sustained period of non-use. The level of distorted thinking is also more extreme than in addiction.

A schizophrenic will have behavioral markers that vary from addictes. And there is the assumption in schizophrenia that the distorted perceptions and thoughts are solely biological. Of couse there is a behavioral component to schizophrenia and behaviors that make things worse.
Of course. Thank you for taking the time to explain what you mean so carefully. It does make a difference, and rather than quibbling back and forth over 'it is / isn't a disease', we can see the real crux of where we disagree; that cognition and choice of actions in a biological entity either is or is not (depending on our respective stances) the direct result of biological functioning.

Athon
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It is a result of biological function, no doubt. Yet I feel there is that multi-value spectrum that allows for the role of choice in cognition.
 
Dancing David said:
It is a result of biological function, no doubt. Yet I feel there is that multi-value spectrum that allows for the role of choice in cognition.
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So why is free will exempt from being described as the result of biological functioning? I don't understand your description of a 'multi-value' spectrum, I'm afraid. Cognitive choice cannot be excluded from biological mechanisms. As I said, there is no ghost in the machine.

Athon
 
Most assuedly, I guess that what I feel is that it may be a biological system without determinism. If a person consumes sugar then there insulin will rise (or lower I am not sure) but there will be an automatic response to the sugar and the insulin level will compensate. The insulin level will rise and fall without the intervention of cognition, although of course behaviors can alter it, like an injection of insulin.

So in depression there are widley aknowledged to be two forms of depression although there is real grey area in between. There is cognitve or mild depression which seems to respond best to CBT and the cognitive reframing of thoughts and alteration of lifestyle. Then on the other end there is the serious biological depression, where without any regard for the CBT and life style changes the depression does not alleviate, althought the CBT and lifestyle changes may ameliorate some of the consequence.

So, my thinking is that there are those who can alter thier depression simply through the choices they make in internal and external behaviors, there are those who can benefit from both, and there are those who need the medication for CBT to have full effect.

At one end of the spectrum there is a form of depression that can be mainly altered by choices on the other end there is depression that will need medication to alleviate, although the CBT and lifestyle changes will have some reduced benefit. So I feel that in one it is simply poor choices being made in thoughts and behaviors and on the other there is a biological driven system that is out of whack. While I aknowledge that the first case of choices can fall under your good definition of disease it can be clearly described as a behavioral disorder. The other end of the spectrum is more likely caused by biology and partly effected by choices.

And so too in addiction (but not exactly), although as the process progresses the biological nature of the systenm will begin to predominate over the choices. Even in the system of choice biology will begin to have stronger effect as the conditioning becomes stronger.

Many alcoholics have a biological vulnerability that will show when they are exposed to alcohol and others will not. The patterns of addicted thinking and behaviors will dominate in some more than others. So I would argue that in the beggining there are alcoholics who have a predominately behavioral form of addiction and there are those who have a more biologicaly influenced form of addiction.

After the addiction progresses it will be much harder to distinguish the two, as the patterns will become more conditioned and habituated.

So grey all the way across and the matter of choice (which may be an illusion) is what i would say is the determinant of how biologicaly driven the system is. On one end very much behavioral on thge other less behavioral and more biologicaly driven.

However, all will benefit from behavior modification.

So I still guess it is me saying that choice while part of a biological system is not biologicaly determined to an outcome, the way a mechanical system that is not increadable compledx or chaotic might be.
 
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skeptigirl said:
How do obsessive-compulsive disorders fit into your scheme of things? Which psychological disorders do you consider a disease and which are not? What defines the difference in brain function? The "out of their control" is the association applied to disease which I, as a medical professional, do not apply.
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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?
 
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