Is alcoholism a disease or something else?

[littleroundman]

I don't recall posting anything other than the dependence criteria, type I and type II are valid categories, due to the probanding in type II and you present quotes from 1990, seriously?

If you read my prior post you would not that I have stated over and over that alcoholism or alcohol dependence is multivariate, so I don't know what you think you are really adding to the conversation.

That wasn't a link directed at your post,

it was, in fact, a lame attempt to demonstrate that for every definition used in a forum discussion, there is "one more" which can be found.

How prevalent is Jellinek's typology in the treatment community, it is really relevant?

In "the treatment community" the answer to the OP question would necessarily be "both" and, Jellinek's typology would be barely relevant.

In terms of the current discussion on THIS forum in THIS thread, where the only things at stake are whether or not the debate is "won" and brownie points scored, (at least in posters' minds) and not billions of peoples' lives, I think it completely relevant that ALL possibilities are outlined, from Jellinek to "da debil made me do it"

What I "believe" is irrelevant.

 

[littleroundman]

Type II diabetes is essentially very different from type I diabetes, it starts as a lack of response to insulin, as opposed to the lack of production, the end effects are the same however. Type II is heavily influenced by the behaviors of the individual, high triglycerides, borderline blood sugars and obesity are all related to the onset of type II.

So in this situation, the multiple biological predispositions and a behavioral component, however I would not classify type II diabetes as a behavioral disorder. I am modifying my behaviors as my maternal grandfather and my mother bother had and have type II diabetes, I take a statin, I exercise regularly, I try not to consume too many carbos and I avoid sugar and alcohol.

The biological predisposition exists however, I am starting to express it, I have had high triglycerides and the borderline blood sugars (even before I became obese).

So there are both components, I have a very strong biological predisposition and need to change my life style. Now I also have alcohol dependence on both sides of my family but that was never my substance of choice.

My question about diabetes was largely rhetorical,

However, your response exposes, once again, it is near impossible to use a "one size fits all" definition to any human condition, ESPECIALLY as the numbers of people involved increases.

Using the broad brush of the "it's all choice" model SOME cases of type II diabetes, can be considered "behavioural" in that the client "chooses" to remain obese and/or "chooses" to smoke and/or "chooses" to not exercise.


HOWEVER, research into type II, at best, only finds that the lifestyle changes indicated can reduce the rate of type II by 80 to 85%

A substantial number of people, granted, but so is the remaining 15 to 20% when compared to the total amount of those with type II diabetes.

Similarly, there are a small but significant number of conditions which either exacerbate or lead directly to type II being diagnosed, the typeII being a side effect of another condition which may/may not itself be "treatable"

 

[MikeSun5]

Yawn. Is Type II diabetes a disease? Or just another character defect?

Again, a topic that was exhausted earlier in this thread. Yawn, indeed.

The comparisons do not work. Type 2 diabetes is a disease just like cirrhosis of the liver. The things that cause those diseases (ie. the person's lifestyle) are not diseases themselves.

 

[Uncayimmy]

My question about diabetes was largely rhetorical,

However, your response exposes, once again, it is near impossible to use a "one size fits all" definition to any human condition, ESPECIALLY as the numbers of people involved increases.

Using the broad brush of the "it's all choice" model SOME cases of type II diabetes, can be considered "behavioural" in that the client "chooses" to remain obese and/or "chooses" to smoke and/or "chooses" to not exercise.


HOWEVER, research into type II, at best, only finds that the lifestyle changes indicated can reduce the rate of type II by 80 to 85%

A substantial number of people, granted, but so is the remaining 15 to 20% when compared to the total amount of those with type II diabetes.

Similarly, there are a small but significant number of conditions which either exacerbate or lead directly to type II being diagnosed, the typeII being a side effect of another condition which may/may not itself be "treatable"

All true, but of what value is it to point out? Type II diabetes has diagnostic criteria. It can be diagnosed without knowing anything about the current or past behavior of the patient. Alcoholism cannot. That's a striking difference. Diabetes is a medical disorder dealing with insulin, type II specifically with insulin resistance. It can happen absent certain behavior, and the certain behavior is not guaranteed to cause it. Alcoholism is defined by the behavior only. There may not be any associated medical condition.

 

[littleroundman]

The comparisons do not work. Type 2 diabetes is a disease just like cirrhosis of the liver. The things that cause those diseases (ie. the person's lifestyle) are not diseases themselves.

The "choice" to not consume food is different from the "choice" of not consuming alcohol, how, exactly ???

Don't eat, no overweight. No overweight, no type II diabetes.

Don't drink, no alcoholism.

See ???

reduced to simple terms, just as the "alcoholism: is ALL choice crew have said.

 

[littleroundman]

Alcoholism is defined by the behavior only.

PARDON ?????

Shouldn't your post read: "MY personal definition is that alcoholism is defined by the behaviour only" ?????

Personally, I think the belief of some religions that the devil is responsible is ludicrous beyond belief.

HOWEVER,

there are a great many more of "them" than there is of "me" and every one of their opinions is just as valid as mine.

If I can find one differing definition than mine, I simply cannot conclude mine is "right"

"similar to" or "nearly the same as" simply don't cut it when speaking in terms of more than 2 cases.

The fact there are many more than "one" definitions alone serves to reinforce that fact, without even needing to venture into causes, treatments or descriptions.

 

[Uncayimmy]

PARDON ?????

Shouldn't your post read: "MY personal definition is that alcoholism is defined by the behaviour only" ?????

Reread my post in context. There is no diagnosis of alcoholism that does not involve behavior. That's the defining factor. If we don't know what a person does, there's nothing else we can do to determine if he's an alcoholic. If you can show me a way, I'm all ears.

 

[littleroundman]

Well,

other than in the "Endogenous opioid systems and alcohol addiction study": Psychopharmacology
Volume 129, Number 2, 99-111, DOI: 10.1007/s002130050169
an abstract of which can be seen here: http://www.springerlink.com/content/d4k3q5pbp05kmy44/

or:
Alcohol dependence: provisional description of a clinical
syndrome
GRIFFITH EDWARDS, MILTON M GROSS
British Medical Journal, 1976, 1, 1058-1061

of which a full review in .PDF format can be reviewed here: http://www.bmj.com/content/1/6017/1058.full.pdf (requires free subscrition to access)
One of my favourite quotes from this study being:

To attempt a definitive description of this syndrome would be premature; much is still only at the stage of "clinical impression."routine clinical questions may impose a pattern on patients' accounts, and patients may themselves organise their uncertain recall of events in terms of expectations given to them. To link the clinical syndrome with information on the psychobiological basis of dependence is difficult, though scientific understanding has advanced recently.

or the:

The Adolescent Brain and the College Drinker: Biological Basis of Propensity to Use and Misuse Alcohol

Linda Patia Spear

a summary of which can be found here: http://www.jsad.com/jsad/article/The_Adolescent_Brain_and_the_College_Drinker_Biological_Basis_of_Propensit/1466.html

each study only serving to reinforce the view there is no singular "answer" to the OP question.

 

[Uncayimmy]

Your first and third links simply points out some of the ways in which alcohol affects the body and how people differ in their response. That doesn't rebut my point about behavior.

Your second link talks about behavior explicitly and thereby reinforcing my point.

Essential elements might provisionally include: a narrowing in the repertoire of drinking behaviour; salience of drink-seeking behaviour; increased tolerance to alcohol; repeated withdrawal symptoms; repeated relief or avoidance of withdrawal symptoms by further drinking; subjective awareness of a compulsion to drink; reinstatement of the syndrome after abstinence.

Like I wrote before, If you want to make the "it's this and something else" argument, then the "this" should be a behavioral problem, not disease.

 

[Uncayimmy]

The "choice" to not consume food is different from the "choice" of not consuming alcohol, how, exactly ???

Don't eat, no overweight. No overweight, no type II diabetes.

If you do not eat, you die. That, of course, is preceded by numerous health issues.

Don't drink, no alcoholism.

Well, that depends on who you talk to. Even the most die-hard alcoholics sleep. They are not drinking at that moment, are they? At what point in the process is someone no longer an alcoholic? A week? Month? 97 days? If they drink just one drink after that time, are they alcoholics again followed by being alcoholics for some set period of time of sobriety? What about people with all the genetic predispositions? Are they alcoholics upon birth?

This is a huge difference compared to traditional diseases. A person who contracts malaria can't go to MA meetings and after a year get a pin for being malaria free. Even the diabetes analogy fails because insulin resistance is always there regardless of behavior (that, and the same behavior doesn't cause the same medical condition everyone who engages).

 

[littleroundman]

What about people with all the genetic predispositions? Are they alcoholics upon birth?

If they have "foetal alcohol syndrome" quite possibly NO ONE knows for sure.

There is no specific medical test for "foetal alcoholic syndrome" nor is there any known cure

What IS known, however, that the little tykes can do a remarkably accurate impersonation of someone with "alcoholism" (note the quotation marks)

In fact, the problems caused by their involuntary consumption of substances containing ethanol may not even become apparent for many years after birth, so, once again, providing a definitive answer is not possible as to whether or not any subsequent "alcoholism" is "nature or nurture" or both.

NO ONE, especially this little black duck can say with any certainty that the involuntary consumption of alcohol/ethanol is not in and of itself the cause of the condition often colloquially referred to as "alcoholism".

 

[Uncayimmy]

If they have "foetal alcohol syndrome" quite possibly NO ONE knows for sure.

Nice work avoiding all of my other questions.

There is no specific medical test for "foetal alcoholic syndrome" nor is there any known cure

What IS known, however, that the little tykes can do a remarkably accurate impersonation of someone with "alcoholism" (note the quotation marks)

Really? Care to present some evidence of this extraordinary claim?

In fact, the problems caused by their involuntary consumption of substances containing ethanol may not even become apparent for many years after birth, so, once again, providing a definitive answer is not possible as to whether or not any subsequent "alcoholism" is "nature or nurture" or both.

Are you calling the damage to a fetus caused by alcohol consumption by the mother alcoholism?

NO ONE, especially this little black duck can say with any certainty that the involuntary consumption of alcohol/ethanol is not in and of itself the cause of the condition often colloquially referred to as "alcoholism".

What are you talking about? I can't parse this in a way that makes sense. It seems to me that you are still hung up on the cause rather than discussing my point that the definition involves voluntary behavior and the "cure" is defined by a change in voluntary behavior. As Dancing Dave and many others have pointed out, there are numerous factors that affect behavior, but that's true of all behaviors.

 

[littleroundman]

No, Yimmy,

there can be no discussion, at least on the part of an enlightened person, about the "cause" of a condition of which there is not a singular definition.

A "definition" which, to be accurate BTW must cover a condition which is present on every continent and within differing cultures.

People who don't claim to know "THE" answer to the OP question hold a an advantage here,

Any more than ONE different definition from more ONE person with qualifications superior to your own and any more ONE person with more than ONE of the many symptoms which makeup what is more correctly referred to as "alcohol related syndrome" and the answer to the OP question: "Is alcoholism a disease or something else?" becomes: "both"

UNLESS, or until, anyone can come out and say definitively "alcoholism" in all the millions of circumstances in which the word can be used, can be contained within a singular definition, with no possible variations within the range of subjects,

OR

or anyone can say definitively: "(the agreed upon definition) is ALWAYS a disease or NEVER a disease or ALWAYS genetic in origin or NEVER genetic in origin or ALWAYS not-any-of-these-things,

then all the linguistic gymnastics in the world are nothing more than (sometimes) entertaining forum chatter.

"UncaYimmy" or "littleroundman" can consider themselves to have won or lost till the cows come home and hell freezes over, and it all comes to nought.

It's all in the numbers.

 

[Dancing David]

In terms of the current discussion on THIS forum in THIS thread, where the only things at stake are whether or not the debate is "won" and brownie points scored, (at least in posters' minds)

Hmm, despite the pissing contests there is a lot of learning that goes on here...

 

[Dancing David]

My question about diabetes was largely rhetorical,

However, your response exposes, once again, it is near impossible to use a "one size fits all" definition to any human condition, ESPECIALLY as the numbers of people involved increases.

Using the broad brush of the "it's all choice" model SOME cases of type II diabetes, can be considered "behavioural" in that the client "chooses" to remain obese and/or "chooses" to smoke and/or "chooses" to not exercise.


HOWEVER, research into type II, at best, only finds that the lifestyle changes indicated can reduce the rate of type II by 80 to 85%

A substantial number of people, granted, but so is the remaining 15 to 20% when compared to the total amount of those with type II diabetes.

Similarly, there are a small but significant number of conditions which either exacerbate or lead directly to type II being diagnosed, the typeII being a side effect of another condition which may/may not itself be "treatable"

And again that is why I use the term multivariate.

 

[Dancing David]

I will not engage certain people in discussion I will however note:

1. There is no single cause of alcoholism
2. One may be born with the genetic predisposition for Tyoe II alcoholism and never be an alcohol addict.

 

[littleroundman]

And again that is why I use the term multivariate.

And why I prefer to use the term "alcohol related disorders" when discussing the subject colloquially referred to as "alcoholism" and to point out that more generalized terms such as "alcoholism" and "diabetes" or "cancer" or "heart attack" are useful only in the broadest conversational sense, and are of little or no value as the starting point of any meaningful understanding or treatment.

 

[xjx388]

I think it's important to note that the only people really worried about whether or not it's a disease are laypeople on an Internet forum. As I said before, doctors don't worry about such labels. They just treat the condition.

Seriously, why are so many of you hung up on a word? Alcoholism is simply alcohol use that interferes with daily living and/or causes health issues. That's essentially it.

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

 

[Uncayimmy]

I think it's important to note that the only people really worried about whether or not it's a disease are laypeople on an Internet forum. As I said before, doctors don't worry about such labels. They just treat the condition.

A claim based merely on your limited personal experience. It's actually something medical experts debate.

http://www.ncbi.nlm.nih.gov/pubmed/1545723
OBJECTIVE: To expound the argument that alcoholism (or "problem drinking") is not best regarded as a disease.

SUMMARY: Excessive drinking can cause physical disease and involve physical dependence without therefore being a disease itself. The "disease concept" of alcoholism is not needed to justify medical intervention or a caring approach to those who are dependent on alcohol. There is a specific and a general version of the disease concept of alcoholism. The specific disease concept, associated mainly with the Fellowship of Alcoholics Anonymous, is contradicted by empirical evidence and unhelpful for preventive and treatment responses to problem drinking, especially for the effort to detect and modify problem drinking at an early stage. The more general disease concept shares these disadvantages and is also ineffective in engendering sympathetic attitudes towards problem drinkers among the general public. It is more useful to view problem drinking as the result of the interaction between the individual's personality and the social context in which he or she has learned how to drink.

CONCLUSION: For an effective and compassionate societal response to problem drinking, the disease model of alcoholism should be replaced by a social learning perspective.

Seriously, why are so many of you hung up on a word? Alcoholism is simply alcohol use that interferes with daily living and/or causes health issues. That's essentially it.

If you're asking that question, then you haven't read the thread.

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

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.

 

[MikeSun5]

The "choice" to not consume food is different from the "choice" of not consuming alcohol, how, exactly ???

Don't eat, no overweight. No overweight, no type II diabetes.

Don't drink, no alcoholism.

See ???

reduced to simple terms, just as the "alcoholism: is ALL choice crew have said.

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!" I used to work for an NPO. You'll say whatever you have to in order to keep those checks coming.

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.