Is alcoholism a disease or something else?

[Dancing David]

We call it "Obsessive Compulsive Disorder" so that posters on internet forums can scoff at the possibility of the condition being a "disease" or the result of chemical, structural or functional abnormalities in the brain.

Those abnormalities are a little different from the ones in 'alcohol addiction' in that most compulsive behaviors are fueled by avoidance of panic attacks, ...

Now there are similarities between OCD and 'alcohol addiction' and in fact many people with OCD become addicts of various sorts.

Yet both are on a spectrum and multivariate and amenable to CBT at some level.

I believe that there is choice along the spectrum, but I would guess that many people with 'alcohol addiction' are dually diagnosed and would need to seek treatment for the other mental health issues. Just as my OCD is held at level without medication through CBT, but resolves with medication.

In my experience with addicts or various varieties (less than 300), the crucial element is that the environment they are in is often the result of many many choices, and therefore they have an equally long set of choices to leave behind their playgrounds and playmates who reinforce the addiction.

 

[Dancing David]

I happen to agree with you here. But it's the neurobiological dysfunction that's the disease, not alcoholism. "Alcoholism" is merely an abstraction to describe a habitual behavior pattern.

Thank you.

 

[Dancing David]

Is your distinction between "Disease" and "Disorder" based on the narrow definition of "Disease" as caused by Pathogens?

Given the level of closed head injuries in people who express OCD, and then the family history, I would say it has a strong biological basis.


[aside]But hey keep poking that Tar Baby all you want... it just sticks to you. [/aside]

 

[Dancing David]

Fine, it's a behavioral disorder. A behavioral disorder that can cause SOME people to have no control over their drinking.

Now this is the point we often don't get past, because then the question of course becomes "What besides the behavioral disorder is playing into the addiction?"

And many people miss that after someone like myself says "I call addictions a behavioral disorder." And I don't push it even though I usually mention it in the relapse prevention model. The point being as many have stated that it is not the ‘why’ that matters as much as the ‘what’ to establish effective treatment.

These are often the motivators behind relapse, although there does seem to be that segment that returns to addiction no matter what.

My list (vastly anecdotal)
1. Biological predisposition (be it response vulnerability or low levels of endorphins)

2. Comorbid mental and physical issues , actually part of (1.) but usually requiring a separate treatment track.

3. Habituation, a biopsychosocial complex of events and changing responses.

4. Consequences:
a. withdrawal, anxiety and associated events some physical some psychological
b. dealing often with the exact situation that they have been hiding from
c. dealing with past events that they regret tremendously
d. continuing stress from work, home and social venues
e. loss of current peer group and support structures
f. shame, guilt and consequences from past events

5. Life style changes from addiction based life style to more normative life style

 

[Dancing David]

You have prescribed the same treatment for three different medical disorders - obesity, depression and alcoholism. If the patient really, really wants to change, all they need to do is make that choice to not over eat, to take a bit of exercise or to not pick up that drink. It's basically The Secret. No matter what neurological, biological, genetic or medical issues may have contributed to the condition, thinking happy thoughts is the way to overcome them.

Another brave warrior fighting the Tar Baby, you are more patient than I.


There is also the fact that choice falls along the spectrum, I am a behaviorist and a big proponent of behavioral treatemnts, however there is always the intersection with biology. In many cases the CBT style choices just are not as effective without changing the biology, I agree with you.

Now having used CBT to hold level with my depression and OCD I personally believe that there are multiple tracks involved, but often the behavioral interventions have to occur away from the triggers. An addict makes the choices not to use long before they are at the liquor store, or in OCD placing valued objects in the same place every time, prior to the onset of compulsion to search for them. (yes, I have looked for my keys in places they could never, ever be.)

 

[Uncayimmy]

What test do YOU employ to decide that ALL "Addicts" ALWAYS have choices?

Answer the question.

I already have. Multiple times. If a person is physically capable of exercising motor control to perform a behavior (or an alternate behavior), has the opportunity to perform that behavior, and is aware of the behavior, I say he has the choice to perform it or not. You have the choice to reply to this post. So, unless you're going to argue that you really don't have a choice, we can agree that choice does exist and at least contains the elements I described.

You and others keep claiming that some addicts are incapable/unable/powerless/lack the functional ability to make those choices. It is your group that is making the distinction that some can and some cannot. It is incumbent upon you to demonstrate how you know this.

 

[xjx388]

If a person is physically capable of exercising motor control to perform a behavior (or an alternate behavior), has the opportunity to perform that behavior, and is aware of the behavior, I say he has the choice to perform it or not. You have the choice to reply to this post. So, unless you're going to argue that you really don't have a choice, we can agree that choice does exist and at least contains the elements I described.

So you say, but you can't find even one study to back you up on this. I've provided 2 papers which link to numerous other studies showing how impairment in the PFC of addicted people impairs a person's executive function; i.e., their ability to make a choice. I think it's reasonable to conclude, based on the evidence, that SOME people can be so impaired that they cannot make a choice, regardless of the fact that they have motor control and the ability to tell the difference between water and alcohol. Until they are treated, they will always crave alcohol as much as they crave food and water.

You and others keep claiming that some addicts are incapable/unable/powerless/lack the functional ability to make those choices. It is your group that is making the distinction that some can and some cannot. It is incumbent upon you to demonstrate how you know this.

This has been demonstrated amply with undisputed scientific evidence. It is now incumbent upon YOU to demonstrate how you know that ALL people are equally functional in the ability to make a choice.

 

[Uncayimmy]

http://lesswrong.com/lw/2as/diseased_thinking_dissolving_questions_about/

Dissolve the question. Is doesn't matter. "Disease" is just a word. Labeling alcoholism as a disease or a behavior does not change the reality of the situation or the potential solutions. It's just bickering over semantics.

No, it's not just "bickering over semantics." The following is from an article entitled, "The Neurobiology of Addiction: Implications for Voluntary Control of Behavior" written by Steven E. Hyman, MD, Provost of Harvard University and Professor of Neurobiology at Harvard Medical School. He states more eloquently many of the points I've made. I disagree with his polarization of the sides using the term "moral condition," but in the context of the article, I understand why he did it.

I think he sums up the battle over the term quite well in this excerpt:

Those who argue for the disease model not only believe it is justified by empirical data, but also see virtue in the possibility that a disease model decreases the stigmatization of addicted people and increases their access to medical treatments. Those who argue that addiction is best conceptualized as a moral condition are struck by the observation that drug seeking and drug taking involve a series of voluntary acts that often require planning and flexible responses to changing conditions - not simply impulsive or robotic acts. They worry that medicalization will lead addicted people to fatalism about their condition and to excuses for their actions rather than full engagement with treatment and rehabilitation and an effort to conform to basic societal expectations.

The reason I object to his use of a "moral condition" is that some of us really don't care one way or another about the morality of addictive behaviors. If somebody wants to drink or get high, that's fine by me. If they do it to "excess," that's fine by me as well. Nobody's perfect. If somebody decides they don't want to be that person, we should have the medical assistance and social support in place to help them while emphasizing that it's going to be a struggle for some to control their behavior, but it can be done.

Yes, it can be done. Another quote from the article.

We cannot select models of human behavior based on desired social implications, but must rely on the scientific evidence we have. Despite somewhat different views of mechanism, all current mainstream formulations agree that addiction diminishes voluntary behavioral control. At the same time, none of the current views conceives of the addicted person to be devoid of all voluntary control and thus absolved of all responsibility for self-control.

He continues with:

Short of being harshly coerced, severely psychotic, or significantly demented, what can it mean to say that a person cannot control his or her actions? An alcoholic must obtain money, go to the liquor store or otherwise obtain alcohol (perhaps carefully hidden from a spouse) and consume drinks. A heroin user may have to go to great lengths to obtain the drug, perhaps committing one of more crimes, before beginning the ritual that ends in self-injection. How can these extended chains of apparently voluntary acts be the result of compulsion? In my view, addictive drugs tap into and, in vulnerable individuals, usurp powerful mechanisms by which survival-relevant goals shape behavior.

The "behaviorists" in this thread have not in any way, shape or form disagreed with any of the above. I've used the liquor store example several times, though it's been ridiculed.


He concludes with:

Finally, views based on cognitive neuroscience and studies of addiction pathogenesis suggest that some apparently voluntary behaviors may not be as freely planned and executed as they first appear. Such cognitive views have not yet penetrated folk psychology, and it is premature for these views to have any place in the courtroom (Morse 2004a; Greene and Cohen 2004). Nonetheless these cognitive views deserve a place in current ethical discussions of personal responsibility. For many reasons, it may be wise for societies to err on the side of holding addicted individuals responsible for their behavior and to act as if they are capable of exerting more control than perhaps they can; however, if the ideas expressed in this review are right, it should be with a view to rehabilitation of the addicted person and protection of society rather than moral opprobrium.

So, really, the notion that medical experts don't "care" about choice is simply wrong. They do. They recognize it, and when push comes shove (at least according to this expert), the research does not say that people are incapable of controlling their behavior.

 

[Gandalfs Beard]

I already have. Multiple times. If a person is physically capable of exercising motor control to perform a behavior (or an alternate behavior), has the opportunity to perform that behavior, and is aware of the behavior, I say he has the choice to perform it or not. You have the choice to reply to this post. So, unless you're going to argue that you really don't have a choice, we can agree that choice does exist and at least contains the elements I described.

You and others keep claiming that some addicts are incapable/unable/powerless/lack the functional ability to make those choices. It is your group that is making the distinction that some can and some cannot. It is incumbent upon you to demonstrate how you know this.

That's not a Scientific Abstract that answers the question I askes, that's just YOUR definition of Choice.

You are the one making the Extraordinary Claim that YOUR definition of Choice applies to EVERYONE.

Back it up with a Scientific Abstract that first provides evidence that YOUR definition of Choice is Scientifically Testable. And with a Scientific Abstract that BY your definition of Choice, that Choice is ALWAYS equally applicable to Everyone.

You've made these claims on more than one thread without providing any data to back them up. It is incumbent upon YOU to back up your claims.


GB

 

[Uncayimmy]

So you say, but you can't find even one study to back you up on this. I've provided 2 papers which link to numerous other studies showing how impairment in the PFC of addicted people impairs a person's executive function; i.e., their ability to make a choice. I think it's reasonable to conclude, based on the evidence, that SOME people can be so impaired that they cannot make a choice, regardless of the fact that they have motor control and the ability to tell the difference between water and alcohol. Until they are treated, they will always crave alcohol as much as they crave food and water.

Impaired <> Incapable.

I'm not getting into the water craving study again, which, by the way, didn't even touch on food. If you want to discuss it, go back to my posts and address my arguments.

This has been demonstrated amply with undisputed scientific evidence. It is now incumbent upon YOU to demonstrate how you know that ALL people are equally functional in the ability to make a choice.

I never said that ALL PEOPLE are equally functional. Choice is a binary proposition. Either it exists or it does not. You said it was "impossible" for your uncle to stop drinking. Obviously for a while you thought he was capable of stopping, otherwise you wouldn't have helped him to the degree you said.

At what point and on what basis did you make the determination that it was impossible for him? I think this is the third or fourth time I've asked. It's a simple question.

 

[Gandalfs Beard]

Given the level of closed head injuries in people who express OCD, and then the family history, I would say it has a strong biological basis.


[aside]But hey keep poking that Tar Baby all you want... it just sticks to you. [/aside]

Point taken.

GB

 

[Uncayimmy]

That's not a Scientific Abstract that answers the question I askes, that's just YOUR definition of Choice.

Do you disagree with my definition of choice?

If you are claiming that some have a choice and some don't, then you must have a definition of choice upon which you are relying. What is it? Maybe we can work with that.

You are the one making the Extraordinary Claim that YOUR definition of Choice applies to EVERYONE.

Sorta. Physical ability, opportunity, and awareness must be present for a choice to exist. If someone lacks any one of those three, choice doesn't exist. I'm not clear why you're disputing this other than to avoid answering the questions put to you.

 

[Gandalfs Beard]

Choice is a binary proposition. Either it exists or it does not.

And you wonder why people keep banging you on this unsupportable "proposition" ?

Your posts are a waste of time responding to.

DD is right.

I'm going back to watching the movie.

GB

PS: And for the record: My definition of choice is that it has a variable range depending on the number of options available. If something limits or inhibits that set of options (say some sort of physiological disorder) then the range of options to choose become smaller, possibly even to nil.

 

[Uncayimmy]

And you wonder why people keep banging you on this unsupportable "proposition" ?

Yes, I do wonder why you call it unsupportable. Choice either exists or it does not. If it exists, then there can be numerous factors influencing that choice.

Put me in an empty room. Do I have a choice to drink? No. (excluding my own urine)

Put a glass of water in the room with me. Do I have a choice to drink? Yes, assuming I am physically capable of drinking, and I am aware that there's a glass of water.

Tell me you'll give me a hundred dollars if I can resist drinking the water for a day and that you'll double the money each day I go without drinking it and that if I allow myself to die of dehydration you'll give my family $10,000,000, then the choice to resist drinking will get progressively more difficult. There will be numerous factors influencing my decision, both positive and negative.

 

[MikeSun5]

Until they are treated, they will always crave alcohol as much as they crave food and water.

Now "craving" is a disease? Or it's under the disease umbrella at least...? Wow. We certainly are a disease-ridden society!

I understand where you guys are coming from, but when you get all worked up and pissed at UY, you miss the points he's making. You say blanket statments (like the one above) and use the word "they" as if your word is the end-all-be-all, too. How do you figure that ALL alcoholics crave alcohol as much as food and water?? How do you figure that they ALL will keep craving booze "until they are treated?" What treatment would you perscribe them ALL? Oh wait, I know -- how about a religious peer-support group? God is a proven cure to the disease called alcoholism, after all.

 

[Gandalfs Beard]

Choice either exists or it does not. If it exists, then there can be numerous factors influencing that choice.

Choice only exists if Options exist. More options = More choices, Less options = Less choices.

GB

 

[Gandalfs Beard]

Now "craving" is a disease? Or it's under the disease umbrella at least...? Wow. We certainly are a disease-ridden society!

I understand where you guys are coming from, but when you get all worked up and pissed at UY, you miss the points he's making. You say blanket statments (like the one above) and use the word "they" as if your word is the end-all-be-all, too. How do you figure that ALL alcoholics crave alcohol as much as food and water?? How do you figure that they ALL will keep craving booze "until they are treated?" What treatment would you perscribe them ALL? Oh wait, I know -- how about a religious peer-support group? God is a proven cure to the disease called alcoholism, after all.

You've got it backwards: UY is the one making the "ALL" statements. And that is what we're responding to.

GB

PS: Nobody on this thread is advocating for a Religious Support Group (except AlBell, and he has wisely stepped away fromthe debate).

 

[MikeSun5]

Well, right after I made my grouchy God Cures Alcoholism post, I found an article that says a pill can cure alcoholism. While this may get a few posters here to feel quite giddy and triumphant, I would like to point out that the pill only reduced the craving for booze... So if "craving" is the disease, then this pill does it! We have a cure, which would pretty much definitively prove that alcoholism is a disease... I guess...

Anyway, blanket statements aside, here's where UncaYimmy's reasoning comes into play:

Of course, it would be your choice as to whether or not you go to a doctor and purchase the pill, or go purchase more booze. Say you have the drugs already... an alcoholic would have to choose between the bottle of pills or alcohol. An analogy would be for overeaters: instead of indulging in food, you can curb your cravings by drinking a few glasses of water. In both cases, the person is presented with a choice: curb your cravings or perpetuate your addiction.

This is why alcoholism is a curious "disease." It (like all addictions) is not like any other disease because there is no reward system for a person with say, syphillis, to not take their medication.

 

[Uncayimmy]

Anyway, blanket statements aside, here's where UncaYimmy's reasoning comes into play:

Of course, it would be your choice as to whether or not you go to a doctor and purchase the pill, or go purchase more booze. Say you have the drugs already... an alcoholic would have to choose between the bottle of pills or alcohol. An analogy would be for overeaters: instead of indulging in food, you can curb your cravings by drinking a few glasses of water. In both cases, the person is presented with a choice: curb your cravings or perpetuate your addiction.

Yep.

 

[xjx388]

I've never made a blanket statement. I've said that SOME addicts are so impaired that they cannot make rational choices. The spectrum of the ability to quit drinking is from "No Problem!" to "It's Impossible!"

Now, let's look at the choices involved in getting help. The addict on the "No Problem!" side of the spectrum can just decide, "Hey, I don't want to be that person anymore!" and quit drinking. Someone in the middle can make the same commitment to change but will have a little more difficulty. Maybe they need support, medical treatment or even admission into a residential detox program. Then we have the extreme, "It's Impossible!" addict. These people have decided that they want to change, but they cannot implement the change. They try to resist alcohol but they crave it too much. They may find a few months of sobriety, but they relapse over and over. They damage themselves, their relationships and put others at risk. Yet they still can't stop. These people are beyond help.

So no blanket statement here.

UY, you keep asking me about my Uncle. I put him on the "It's impossible" part of the spectrum. I was 20 years old when he died. I didn't really know him. My father and his sisters decided he was beyond help after the 3rd or 4th time they paid for a detox program. He had been sober for a few months, lived with my Aunt and somehow got his hands on some hooch. He got so drunk he put the moves on my Aunt and her husband kicked him out. He pretty much was homeless after that and died shortly thereafter.

Now, how can you know that he could have been helped?