Is alcoholism a disease or something else?

I'm still curious as to why alcoholism is called a disease almost only in North America. I tried looking up stats on addiction funding in other countries but wasn't really successful. :(

Is it North America or just the US? If it's only the US, I suspect it has something to do with the health care system.
 
I was just addressing AlBell's comparison of diabetes to alcoholism that had been brought up earlier in the thread. Simplification was warranted in that context. Because he started it. ;)

Also, I don't really see what's bad about wanting to reduce things to simple terms anyway...

The more I look at it, alcoholism is a mental disorder that can lead to sickness and diseases. IMO, it's only called a disease when it helps the organization maintain or get more funding. As said earlier, alcoholism orgs. get more funding than addiction orgs. The Mayo Clinic actually separates "alcoholism" and "alcohol abuse" to account for all the posters on this thread who say, "I was an alcoholic I never had a disease!" :rolleyes: I used to work for an NPO. You'll say whatever you have to in order to keep those checks coming. :D

I'm still curious as to why alcoholism is called a disease almost only in North America. I tried looking up stats on addiction funding in other countries but wasn't really successful. :(

In the US, I think it mostly has to do with the socio-political climate. The Puritan Temperance Movements were the most successful in the US which led to Prohibition and AA. The founders of AA--being Protestant Christians--conflated the "Sin" Model of "Addiction" with the "Disease" Model of "Addiction," which essentially became the Standard Model for ALL Drug and Alcohol use.

Dr Silkworth who wrote the Preamble to the Big Book considered Christ the Great Physician (and only He could truly save the Alcoholic) and passed along this idea to Bill Wilson. Add to this the Hearst campaigns against Marijuana and the political climate was set for decades to come, right to this very day.

Add in Economic Incentives for Big Pharma and a For Profit medical system, and the Disease Model gets locked in place. Though at least in the last few decades the Medical Community (and to varying degrees the Judicial Community) has been distancing the Disease Model from the Sin Model, which is an improvement.

But to this day in the US, no politician can get elected without vowing to continue the dubious Drug Wars; and the Just Say No campaigns of the 80's continued to keep in place a Socio-Political Stigma against all forms of "Addiction," and "illicit" drug use in general.

This is essentially my whole beef with "Addiction Ideology" in the US (which has affected to varying degrees drug and alcohol policies in the countries of some US allies).

But given that, I still do not think that all "addictions" are equal, and that in some cases a Behaviourist approach can be most beneficial (for those whose capacity to make decisions/choices to help themselves hasn't been compromised), and in others, a neuro-biological approach is most appropriate (for those whose capacity to make choices HAS been compromised. If the medical community wants to call those with serious neuro-biological "addictions" a "Disease" I really don't have a problem with that).

And in many cases I think alleged "addicts" are best left to their own devices if drug use and alleged "abuse" aren't causing significant disruptions in a person's life.

GB
 
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Calling it a disease that is "impossible" to control for some people is the best excuse to keep drinking.
Who declared alcoholism "impossible" to control?

ps. Alcoholics need no excuse to keep drinking ... damn moral degenerates.
 
Who declared alcoholism "impossible" to control?
Please do me the courtesy of reading the post to which I was responding. Had you done so, you would have seen that I was replying to, "It's impossible for some people to control their behavior and it's easy for others."

ps. Alcoholics need no excuse to keep drinking ... damn moral degenerates.
As I have said several times, I have no moral issues with alcohol or alcoholics. Why you insist on dragging these moral judgments into it is beyond me.
 
Please do me the courtesy of reading the post to which I was responding. Had you done so, you would have seen that I was replying to, "It's impossible for some people to control their behavior and it's easy for others."


As I have said several times, I have no moral issues with alcohol or alcoholics. Why you insist on dragging these moral judgments into it is beyond me.

For all my beefs with AA (and I have plenty), I think the First Step is true for SOME people. In other words, for SOME people, controlling Alcohol Drinking IS impossible without intervention and help (regardless of the numerous factors that may play into that).

Why is it so hard for you to just admit that this is the case, and that you're not Psychic enough to know that for every single "Alcoholic" saying "it's impossible" is the "best excuse"?

...Or for that matter, to admit that 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?

The very fact that you put it in terms like "best excuse" belies your contention that you have "no moral issues with alcohol or alcoholics." This is the same kind of double-talk argument that you used on the other thread that drives people crazy.

You claim you have "no moral issue", but that fat people and drunk people have "no excuse" not to make choices, which boils down to "it's all their own fault."

It's no wonder that AlBell sarcastically called you on it: "...damn moral degenerates."

This is exactly what I'm talking about when I bring up the socio-political background assumptions that stigmatize people for the problems they face. SOME people don't even realize they are making a snap moral judgment when that is precisely what they are doing.

GB
 
A claim based merely on your limited personal experience. It's actually something medical experts debate.
Maybe there is a debate in academic circles, but not in clinical practice. The debate that does exist (as your paper shows) concerns the best way to treat Alcoholism and what the best frame of reference is for doing so. Doctors don't care about what you call it. Alcoholism is a useful tag (=patient has problem with alcohol), just as Diabetes is (=patient has insulin problems), just as is every other word they assign to describe any condition of the human body. It's not as if there are two camps in Medicine arguing over whether it's a disease or not.

Patient has a problem with alcohol = we can treat it =/= it is or isn't a disease.

If you're asking that question, then you haven't read the thread.
Oh, I've read the thread. The question remains: why do you personally care if it is called a disease or not? How is it going to affect your life or the treatment of people with Alcoholism.

This is precisely why the discussion matters. You're taking the onus off the individual to alter their behavior (there is no gene that makes people buy a bottle of Early Times and drink shots until they pass out) and putting it on medical professionals. The best the medical profession can do is offer assistance to people willing to make changes. Calling it a disease that is "impossible" to control for some people is the best excuse to keep drinking.
So calling something a disease = giving people an excuse? Nope, sorry. Calling it a disease is just a useful conceptual model for the medical community to understand it better and develop treatments. Call it a lifestyle choice if you want to but that conceptual model hasn't helped anyone get over Alcoholism.

What you can't seem to grasp is that for some people, Alcoholism is impossible to control. Sorry if that messes with your world view, but it's a stone cold fact. All the interventions in the world won't save some people. They'll sober up for a few days or months, then right back on the bottle until they die of the damage they've done to their body. That's just reality.

We can argue back and forth (and we have, ad nauseum)whether or not they are "choosing" to remain alcoholics, but that is a purely philosophical argument and not a meaningful and practical one.
 
Gandalfs Beard said:
SOME people don't even realize they are making a snap moral judgment when that is precisely what they are doing.

Believe it or not, there areSOME people who know EXACTLY what they are doing, so they attempt to conceal their personal moral views behind a cloak of "intellectual debate"
 
For all my beefs with AA (and I have plenty), I think the First Step is true for SOME people. In other words, for SOME people, controlling Alcohol Drinking IS impossible without intervention and help (regardless of the numerous factors that may play into that).
Well, quite frankly, nobody does anything in this world without some help along the way. It's all a matter of degree. Still, explain to me how you test for impossible. I say if they have voluntary motor control and awareness, then there's choice involved.

Why is it so hard for you to just admit that this is the case, and that you're not Psychic enough to know that for every single "Alcoholic" saying "it's impossible" is the "best excuse"?
Considering I never said any such thing, I don't see why you brought it up.

...Or for that matter, to admit that 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?
I never said that genetic predispositions don't exist or that they don't play a role. I don't see why you brought it up.

The very fact that you put it in terms like "best excuse" belies your contention that you have "no moral issues with alcohol or alcoholics." This is the same kind of double-talk argument that you used on the other thread that drives people crazy.
Only because you want to see me as making moral judgments. I've seen people time and again use the excuse of how it's a "disease" and that it's "impossible" to control for their continued avoidance of assistance. That is until they decide they don't want to be that person anymore. It is what it is. I really don't care about them personally. Really, I don't. To me it's no different than somebody incorrectly claiming that their car is out of gas, so they can't drive to the store. I happen to know the car has gas. I know they will never drive anywhere until they figure it out.

You claim you have "no moral issue", but that fat people and drunk people have "no excuse" not to make choices, which boils down to "it's all their own fault."
You're boring me. Again. You take this issue so emotionally that it colors your arguments and prevents you from interpreting ordinary statements in a dispassionate manner. I grow weary.
 
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Why the heck is it I keep getting a picture in my mind of a bloated King Henry the Eighth type character dismissively waving a silk 'kerchief at his inferiors and proclaiming "go away, you bore me" ????

It's the strangest thing.



Or, maybe not.
 
Still, explain to me how you test for impossible. I say if they have voluntary motor control and awareness, then there's choice involved.
The real world is ample evidence for me. Some people cannot stop drinking and they die from the damage. For those people, it was impossible to stop. Pointing out that they have motor control and giving them awareness that their drinking is the cause of their problems has not been shown to be effective. Maybe you should explain how you test for choice?

Only because you want to see me as making moral judgments. I've seen people time and again use the excuse of how it's a "disease" and that it's "impossible" to control for their continued avoidance of assistance. That is until they decide they don't want to be that person anymore.
This is very interesting . . . In what capacity have you "time and again" seen these people?

And honestly, how can you say that you aren't making moral judgements?

I say if they have voluntary motor control and awareness, then there's choice involved.
Calling it a disease that is "impossible" to control for some people is the best excuse to keep drinking.

Moral judgements, the both of them.

Here's the funniest thing I've read in this thread concerning how we define diseases:
A person who contracts malaria can't go to MA meetings and after a year get a pin for being malaria free.
So if it has a support group it's not a disease? :rolleyes:
 
Yimmy said:
A person who contracts malaria can't go to MA meetings and after a year get a pin for being malaria free.

The master of the use and abuse of the "that's a straw man argument" tactic strikes yet again !!!!!!

We can't be define someone as being an "alcoholic" by having them contract malaria, either.

OH, WAIT !!!!

We haven't even agreed on a definition for "alcoholic" yet, how could we ????
 
The real world is ample evidence for me. Some people cannot stop drinking and they die from the damage. For those people, it was impossible to stop.
I see. Because they don't, it was impossible. Can't argue with that logic.

Maybe you should explain how you test for choice?
I have, multiple times. You don't find it convincing because you believe that those who don't cannot. I can't help you in that regard.

And honestly, how can you say that you aren't making moral judgements?
Moral judgments deal with right and wrong. I don't consider alcoholics immoral. It's really that simple.

Here's the funniest thing I've read in this thread concerning how we define diseases:So if it has a support group it's not a disease? :rolleyes:
If that's what you got out of my statement, I can't help you.
 
I see. Because they don't, it was impossible. Can't argue with that logic.
For all practical purposes, yes it was impossible for that person.

I have, multiple times. You don't find it convincing because you believe that those who don't cannot. I can't help you in that regard.
You can skirt the core issue and wave your hand all you want to but it won't make you more right. Let's see, who has more credence on this matter, some random dude on the internet or the National Institutes of Health (you know, the federal agency that makes PubMed available and has access to all the studies and current thinking on all things Medicine?):
1. What is alcoholism?

Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:

  • Craving --A strong need, or urge, to drink.
  • Loss of control --Not being able to stop drinking once drinking has begun.
  • Physical dependence --Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
  • Tolerance --The need to drink greater amounts of alcohol to get "high."

2. Is alcoholism a disease?

Yes, alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems.

Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle. (See also "Publications," Alcohol Alert No. 30: Diagnostic Criteria for Alcohol Abuse and Dependence.)

Wow, so NIH recognizes that Alcoholism is a disease with specific diagnostic criteria/symptoms?!? And that it may not be possible for an Alcoholic to control their drinking?!? And that, for some, the craving to drink is as strong as the need for food and water?!? :jaw-dropp Good enough for me and just about every doctor in America.


Moral judgments deal with right and wrong. I don't consider alcoholics immoral. It's really that simple.
So, it's neither right nor wrong for a person to choose to hurt themselves and others by choosing to remain an alcoholic? Right. :rolleyes:

If that's what you got out of my statement, I can't help you.
You are arguing that Alcoholism is not a disease. You bring up the fact that people who get Malaria (a disease) don't have MA meetings and get pins for being 1 year Malaria free. So what was I supposed to conclude from your little example?
 
For all practical purposes, yes it was impossible for that person.
Putting "for all practical purposes" in front of it doesn't make it any better. And we weren't talking about a specific person. In fact, nobody here has even described a person for whom it is impossible.

You can skirt the core issue and wave your hand all you want to but it won't make you more right. Let's see, who has more credence on this matter, some random dude on the internet
Ah, you're back to the credentials thing again. How surprising!

Wow, so NIH recognizes that Alcoholism is a disease with specific diagnostic criteria/symptoms?!? And that it may not be possible for an Alcoholic to control their drinking?!? And that, for some, the craving to drink is as strong as the need for food and water?!? :jaw-dropp Good enough for me and just about every doctor in America.
NIH is wrong. There is no evidence showing that the craving is as strong as that for food and water. It's hyperbole at its best. They are wrong to say that people cannot stop drinking once they start because they do stop (and then start again later).

As others have pointed out, this "definition" seems to be an American thing. Over in the UK they phrase it differently. They write, "Dependent means that a person feels that they are unable to function without alcohol and the consumption of alcohol becomes an important – or sometimes the most important – factor in their life." (emphasis added) They go further and divide it into three categories: hazardous drinking, harmful drinking, and dependent drinking.

You can dismiss my opinions as some random person on the Internet if you want. You, of course, would be ignoring the experts I have quoted. It's much easier for you that way.


So, it's neither right nor wrong for a person to choose to hurt themselves and others by choosing to remain an alcoholic? Right. :rolleyes:
It's not wrong to play football either, and that hurts the individual. Free climbing is extremely dangerous. Not wearing your CPAP every night is dangerous and harmful. People engage in all manner of activities that are harmful in the short and long term. Don't project your moral judgments on me.

You are arguing that Alcoholism is not a disease. You bring up the fact that people who get Malaria (a disease) don't have MA meetings and get pins for being 1 year Malaria free. So what was I supposed to conclude from your little example?
You should conclude that behavior does not "cure" malaria because behavior is not part of the definition of traditional diseases. Even something like type 2 diabetes is not defined by behavior but by the underlying medical condition it causes. The behavior may or may not cause the condition. Ceasing the behavior may effect the condition, but we can determine the presence of the condition without knowing about behavior. Basically, there's no way for a doctor to know if you're an alcoholic without looking at your behavior, and a doctor can only influence you to change your behavior.
 
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Maybe there is a debate in academic circles, but not in clinical practice.
Right, because clinicians don't read the journals. Except, of course, when it supports their dogma.

It's not as if there are two camps in Medicine arguing over whether it's a disease or not.
Sure there is. A lot of it depends on where you live and how the government describes it.

http://www.ncbi.nlm.nih.gov/pubmed/15204209
The intent of this study was to explore differences in views concerning the statements "alcoholism is a disease" and "alcoholism is a self-induced disease" among doctors in two cities from two contrasting countries, relating to different official definitions of alcoholism, namely Denmark, where alcoholism is related to ways of lifestyle and Germany, where alcoholism is related to preliminary diseases. The data come from a postal anonymous survey, carried out between January and February 2000 in Aarhus and Mainz, sent to general practitioners and hospital doctors from surgery, internal medicine and psychiatry. The identified sample was n = 572, and the response rate = 66% (n = 374). As opposed to doctors in Aarhus (73.7%), significantly more doctors in Mainz (92.4%) described alcoholism as a disease, but independent of nationality, about half of the samples (no gender, age and healthcare settings differences) also agreed that "alcoholism is a self-induced disease". The governmental position on alcoholism seems to have an influence on doctors' evaluation: in Denmark, where alcoholism is defined as a disease of lifestyle, doctors in Aarhus were less likely to describe alcoholism as a disease than in Mainz, where alcoholism is seen as a preliminary disease. The ideological background for these differences is connected to the different influence of the temperance groups on the alcohol field -- less in Denmark and more in Germany. However, half of the doctors in Aarhus and Mainz viewed alcoholism as a self-induced disease and so indirectly assumed that alcoholics are responsible for their self-afflicted disease.

Oh, I've read the thread. The question remains: why do you personally care if it is called a disease or not? How is it going to affect your life or the treatment of people with Alcoholism.
Seems overly personal and vague to me. Try again.

So calling something a disease = giving people an excuse? Nope, sorry.
The traditional definition of a disease says:

1) A disease has a biological basis. Everything we do has a biological basis and is related to genetics. It's a major twisting of this requirement to cite genetics as a biological basis for pouring shots of whiskey and drinking them until you're drunk. If drinking booze qualifies, then I can't think of any activity we would exclude based on this requirement, so why include it?

2) A disease has identifiable signs and symptoms. This is another interesting one. If the addict doesn't tell you about his behavior, you can't identify the symptoms. It also reduces "signs and symptoms" to include things like getting a haircut or watching football, which enables this criterion to be used to classify anything as a disease.

3) A disease has a predictable course and outcome. This is another stretch for alcoholism/addiction since it simply describes voluntary behaviors. This interpretation allows to classify many activities (going to college) as a disease.

4) A disease’s condition is not caused by volitional acts. It's a brutal torturing of this criterion to include buying a bottle of Early Times and drinking shots until you pass out.

Using the above with the same sort of tortured interpretation, we could classify all sorts of things as diseases.

What you can't seem to grasp is that for some people, Alcoholism is impossible to control.
You keep saying that without presenting any evidence. It's just an assertion. In the UK they acknowledge that it seems impossible. There's a big difference. If it's impossible to control, then why are you treating them with anything other than a paralytic??

We can argue back and forth (and we have, ad nauseum)whether or not they are "choosing" to remain alcoholics, but that is a purely philosophical argument and not a meaningful and practical one.
Except that the only way you know that someone is "cured" is if they stop drinking. If it was impossible for them to control it, then what magic did you work? Or maybe it only seemed impossible, and the person learned strategies to control their behavior. That's very practical.
 
Except that the only way you know that someone is "cured" is if they stop drinking. If it was impossible for them to control it, then what magic did you work? Or maybe it only seemed impossible, and the person learned strategies to control their behavior. That's very practical.

An alcoholic is not cured because he stops drinking. The alcoholism is still a problem. Prolonged use of alcohol changes the responses in a person's brain. The pathways used for reward and pleasure are permanently affected. If that person were to drink again, there is a good chance that they would repeat the pattern of alcohol abuse.

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.
 
Wow, so NIH recognizes that Alcoholism is a disease with specific diagnostic criteria/symptoms?!? And that it may not be possible for an Alcoholic to control their drinking?!? And that, for some, the craving to drink is as strong as the need for food and water?!? :jaw-dropp Good enough for me and just about every doctor in America.

Still ignoring the moneymaking potential of a disease vs. addiction in America, I see... Since you brought up the NIH, we'll use them. ;) This table shows the NIH received over $450 million in funding for alcoholism this year. That is a lot of money given to one specific addiction when other addictions (smoking, overeating) must be lumped in together with other categories. Some addictions (gambling, shopping, sex) aren't even listed, which means if they receive any funding at all, it's a small part under a broad category. The NIH was given over $2billion in funding for "Mental Health." If alcoholism was included under that enormous category, researchers would most likely NOT get 25% of that, and therefore would receive less than they do now. Of course if alcoholism stands alone as a disease, they can get their own funding.

Also, I found it weird that the NIH was given $526 million (quite a bit more than alcoholism) to research "Complimentary and Alternative Medicine." :eye-poppi So..... anyone want to say NIH isn't in it for the money now? ;)
 

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