Is alcoholism a disease or something else?

[xjx388]

You claimed quite forcefully that it was impossible for him. I'm asking how you know. So, are you saying you don't know?

I'm reasonably certain. Maybe a new study will come out tomorrow with a new breakthrough that challenges my thinking. Until then, the biopsychosocial disease model is, IMO, the best representative of reality. That's how I know.

In other words you cannot articulate how you came to this conclusion. Is that correct?

I think I've articulated it very well. If you don't accept it, that's another issue entirely.

Impairment <> Unable

How do you know this? How much ability is left with severe impairment?

I invite you to respond to post #668 where this is addressed by someone far more qualified than myself.

Yes, so much more qualified that you don't even understand what he's actually trying to say. First of all, let me say that Dr. Hyman's article does not support your position as much as you think it does. More importantly, Dr. Hyman makes clear that:

There continues to be a debate on whether addiction is best understood as a brain disease or a moral condition.

You seem to think (and you are the only one) that there is a third view that assigns no morality to abusive drinking. Well if it isn't morality and it isn't a disease that harms people, then why do we need to spend anytime at all talking about it? If it's a mere choice, like the decision to play rugby, then who cares if people make it?

In the meantime, it appears you are assuming that drinking is an irrational choice. In itself drinking is not irrational. Even with a chronic alcohol abuser, any single choice to drink is not necessarily irrational. Every day every one of us makes choices based on numerous (even countless) factors. We weigh short term and long term pros and cons, often subconsciously.

So it's not irrational to choose to drink even if it means you will kill your liver, alienate your family, and end up killing yourself?!? That's crazy talk. It's not irrational for me to drink because I can drink a couple of beers and stop; it causes me no harm. But it was certainly irrational for my Uncle to drink even one sip of whisky because he could not stop even though it was killing him. How can you not understand this?

Who are you to say that it's "irrational" for someone to get hammered? In the grand scheme of things, what's one evening of getting drunk? I can get sober tomorrow - one more binge won't make a hill of beans of difference.

Getting drunk feels good. Maybe it satisfies a craving. Maybe it makes me forget about some emotional pain. Maybe it lets me escape from stress. Hell, maybe I just don't like my job and if I show up hungover one more time they will fire my ass, which is fine by me anyway - the boss is a bastard.

This whole argument is irrational.

We "sober" people look at a long-term pattern of behavior and conclude that it's "irrational" to live your life as a drunk. In reality, it's a series of individual decisions that, in my not so humble opinion, make pretty good sense at the time. It's sucks to give up short term benefits for long term benefits.

So it's not irrational to live life as a drunk? Well then, we should just pack this thread up now, huh?

This is why the paradigm of "choicers" is so superior compared to the "it's impossible" crowd. We start with the person acknowledging that no disease is making them get money, procure liquor, hide it from a spouse, and pour drinks. That's their decision, and at the time, it probably seems pretty rational. When the person decides they don't want to be the person who engages in a long-term pattern of self-destructive behavior, then that person can attack the problem head on, whatever it is.

This is precisely the problem! They are deciding to carry out behaviors that are killing them, physically and psychologically, and it seems rational at the time. It's like if I decided to jab a knife into my throat because it seemed like a good idea at the time. Maybe I like pain. Maybe it helps me forget my troubles for awhile. Maybe I won't have to go in to work tomorrow because I have a big gash in my neck. Is this a rational behavior?

If it's depression, treat it. PTSD? Treat it. Stress? Treat it. Environment? Change it. Intense cravings? Try some medications and stop reinforcing the craving. It just feels good? Find something else to do. Just an unthinking habit? Make new thinking habits. Chances are it's probably a combination of several things.

Now here's somewhere where you start to make a little more sense. Some of these things can work for a lot of people a lot of the time -absolutely. However, you are forgetting (conveniently) about a couple of points Dr. Hyman brought up in his paper:

Because the changes in synaptic weight and synaptic structure that underlie memory are among the longest-lived alterations in biology, the ability of drug-related cues to cause relapses may persist for many years, even a lifetime.

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 psychologyi.e. UncaYimmy's views. . .

In the end, Hyman is arguing that:

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

In other words, hold them legally and ethically responsible for their actions even though they really don't have control over them. 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.

It may take years to get on track, but the only constant in all of this is figuring out why you're making the choices you're making and finding ways to make better choices for the rest of your life by using any and all available resources.

Yes, absolutely for most addicts. But for some people it doesn't take years . . . it takes, as Dr. Hyman pointed out, a lifetime.

 

[Zelenius]

What, exactly, do you think my "approach" is? MikeSun gets it. I'm not against medication in the least, but it's still a choice to take medication. If there is an underlying pain for which a person is self-medicating, then dealing with that pain by whatever means is still a choice.

As I said before, alcoholism, unlike traditional diseases, cannot be cured surreptitiously. By that I mean you could slip some meds unknowingly to (say) someone with malaria and cure them. There's nothing you can do for an alcoholic like that. Their will, however strong or weak it is, has to be part of the cure in the form of making choices.

Your position seems to make "choice" seem to be independent of biology, when it is fully dependent on one's biochemical make up. It's almost as if you're presupposing dualism

Strictly speaking, I do not believe that alcoholism is a disease, but it is useful to see it as a disease in certain people in certain contexts. Rather, it is the genetic/biological defect that manifests as alcoholism(or other addictive behavior) that is a disease.

Alcoholism cannot be cured surreptitiously? What if the wife of an alcoholic surreptitiously puts acamprosate(a drug that reduces alcohol cravings - http://pn.psychiatryonline.org/content/39/17/30.1.full). Let's say her alcoholic husband has refused to take this medication, and yet gets it everyday when his wife puts it in his food. For argument's sake, let's assume the drug if very effective and let's assume he has no clue she is putting it in his food. As a result of this, his alcohol cravings subside to the point that he no longer feels the need to drink. In my view his "alcoholism" could be said to be successfully "cured" or "treated" since he is no longer consuming alcohol. The defective genes are still there, but its effect has been neutralized by the medication.

So in this scenario, what is more important, the alcoholic's "choice" not to drink or the medication that greatly reduces his alcohol cravings?

 

[Uncayimmy]

Your position seems to make "choice" seem to be independent of biology, when it is fully dependent on one's biochemical make up. It's almost as if you're presupposing dualism

I have no idea what that means.

Alcoholism cannot be cured surreptitiously? What if the wife of an alcoholic surreptitiously puts acamprosate(a drug that reduces alcohol cravings - http://pn.psychiatryonline.org/content/39/17/30.1.full). Let's say her alcoholic husband has refused to take this medication, and yet gets it everyday when his wife puts it in his food. For argument's sake, let's assume the drug if very effective and let's assume he has no clue she is putting it in his food. As a result of this, his alcohol cravings subside to the point that he no longer feels the need to drink. In my view his "alcoholism" could be said to be successfully "cured" or "treated" since he is no longer consuming alcohol. The defective genes are still there, but its effect has been neutralized by the medication.

So in this scenario, what is more important, the alcoholic's "choice" not to drink or the medication that greatly reduces his alcohol cravings?

Those drugs reduce cravings. People who take it still abuse alcohol. It is not a "cure" because cravings are not a disease.

 

[Skeptical Greg]

.................
So in this scenario, what is more important, the alcoholic's "choice" not to drink or the medication that greatly reduces his alcohol cravings?

Looks like " choice " would still be the deciding factor ...

How could it not be ?

 

[Skwinty]

To be, or not to be - that is the question.

 

[Uncayimmy]

I'm reasonably certain. Maybe a new study will come out tomorrow with a new breakthrough that challenges my thinking. Until then, the biopsychosocial disease model is, IMO, the best representative of reality. That's how I know.
I think I've articulated it very well. If you don't accept it, that's another issue entirely.

You quite clearly are unable to articulate how and when you determine that it's impossible for someone.

How do you know this? How much ability is left with severe impairment?

How do I know that Impairment <> Unable? What kind of question is that? They are two different words. We say impaired when we mean impaired and unable when we mean unable.

Yes, so much more qualified that you don't even understand what he's actually trying to say. First of all, let me say that Dr. Hyman's article does not support your position as much as you think it does. More importantly, Dr. Hyman makes clear that: You seem to think (and you are the only one) that there is a third view that assigns no morality to abusive drinking. Well if it isn't morality and it isn't a disease that harms people, then why do we need to spend anytime at all talking about it? If it's a mere choice, like the decision to play rugby, then who cares if people make it?

Reply to the post in question, please.

So it's not irrational to choose to drink even if it means you will kill your liver, alienate your family, and end up killing yourself?!? That's crazy talk.

Quite clearly you started your reply without reading my entire post first. That's very annoying, and it makes discussions exceedingly difficult.

It's not irrational for me to drink because I can drink a couple of beers and stop; it causes me no harm. But it was certainly irrational for my Uncle to drink even one sip of whisky because he could not stop even though it was killing him. How can you not understand this?

How do you know what his thought process was? You are imposing your values - your moral values - on your uncle and concluding that each decision to drink was irrational.

So it's not irrational to live life as a drunk? Well then, we should just pack this thread up now, huh?

I never said any such thing. What I said is that a series of "rational" decisions can be irrational as a whole.

In the study you incorrectly claim proves that the craving for alcohol is as strong as the need for water they ask questions to effect of, "Would things be better if I took a drink right now?" The answer "yes" because it's true. It's no different than you or I having a stressful day at work and deciding a glass of wine would make things better. In the short term, it works. Why? Because of the effect on the pleasure pathways that end up rewiring our brains.

The whole point of behavior modification is to get people to think in a different way. Sure, in the short term a drink might make things better, but in the long term, it's not a good idea for that person. In the short term the person needs to learn alternative behaviors besides drinking to "make things better."

It seems like some of you have a vision of Bela Lugosi locking himself in his bedroom and chaining himself to the bed because there's a full moon, and he doesn't want to harm anyone when he turns into the wolfman. That's not how it works. In reality the person is affected by a number of influences, biological and environmental, concluding that the best course of action at that moment is to take a drink.

We both want to help that person. You want to tell him that he has a disease and that "based on science" you know it's impossible for some to control. I want to tell them that this is a voluntary behavior that they can control but only if they acknowledge their responsibility to control their behavior. Once they accept that, they can look at all of the factors influencing them and tackle them one at a time using whatever means are necessary (medication, rehab, therapy, relocation, etc). Attacking each factor is a choice they have to make.

 

[Gandalfs Beard]

You quite clearly are unable to articulate how and when you determine that it's impossible for someone.


How do I know that Impairment <> Unable? What kind of question is that? They are two different words. We say impaired when we mean impaired and unable when we mean unable.


Reply to the post in question, please.



Quite clearly you started your reply without reading my entire post first. That's very annoying, and it makes discussions exceedingly difficult.


How do you know what his thought process was? You are imposing your values - your moral values - on your uncle and concluding that each decision to drink was irrational.


I never said any such thing. What I said is that a series of "rational" decisions can be irrational as a whole.

In the study you incorrectly claim proves that the craving for alcohol is as strong as the need for water they ask questions to effect of, "Would things be better if I took a drink right now?" The answer "yes" because it's true. It's no different than you or I having a stressful day at work and deciding a glass of wine would make things better. In the short term, it works. Why? Because of the effect on the pleasure pathways that end up rewiring our brains.

The whole point of behavior modification is to get people to think in a different way. Sure, in the short term a drink might make things better, but in the long term, it's not a good idea for that person. In the short term the person needs to learn alternative behaviors besides drinking to "make things better."

It seems like some of you have a vision of Bela Lugosi locking himself in his bedroom and chaining himself to the bed because there's a full moon, and he doesn't want to harm anyone when he turns into the wolfman. That's not how it works. In reality the person is affected by a number of influences, biological and environmental, concluding that the best course of action at that moment is to take a drink.

We both want to help that person. You want to tell him that he has a disease and that "based on science" you know it's impossible for some to control. I want to tell them that this is a voluntary behavior that they can control but only if they acknowledge their responsibility to control their behavior. Once they accept that, they can look at all of the factors influencing them and tackle them one at a time using whatever means are necessary (medication, rehab, therapy, relocation, etc). Attacking each factor is a choice they have to make.

Yet many people are literally unable to make those "choices" due to their choice inhibiting problems, and end up in jail, a gutter, or dead.

GB

 

[Uncayimmy]

Yet many people are literally unable to make those "choices" due to their choice inhibiting problems, and end up in jail, a gutter, or dead.

GB

Once again, on what basis do you determine that they are "literally unable" to make those choices? Since you mention jail, there are severe legal implications. If we are jailing people "literally unable" to make lawful choices, then that is clearly wrong in my book. You don't say that "all" people are "literally unable," so how do you differentiate the two? Forget everything I've said and just answer the question. It's extremely important to know how to do this. The implications for the medical community, legal community and society at large are enormous.

Also, please read this post and respond because it deals directly with this issue.

 

[xjx388]

Let me try the UncaYimmy Obfuscation Game. It looks like fun!

You quite clearly are unable to articulate how and when you determine that it's impossible for someone.

You are quite clearly unable to comprehend basic English.

How do I know that Impairment <> Unable? What kind of question is that? They are two different words. We say impaired when we mean impaired and unable when we mean unable.

You are quite clearly unable to articulate how you know that "Impairment<>Unable." You also don't understand that impairment affects ability: Moderately impaired = Moderately unable. Totally impaired = Totally unable.

Reply to the post in question, please.

Read my reply to the post in question. You seem unable to comprehend my words when I write them. I covered this in my response.

How do you know what his thought process was? You are imposing your values - your moral values - on your uncle and concluding that each decision to drink was irrational.

How do you know what his thought process was? You are imposing your values - your moral values - on my uncle and concluding that he always had a choice to drink or not to. This is a fun game!

I never said any such thing. What I said is that a series of "rational" decisions can be irrational as a whole.

No you didn't. You said that we sober people conclude it's irrational but in reality it's a series of choices that make sense at the time. You never said it actual was irrational as a whole only that sober people conclude so. If you want the things you say to mean what you mean them to say, then say what you mean so that I can understand your meaning.

Straw Man AlertIn the study you incorrectly claim proves that the craving for alcohol is as strong as the need for water they ask questions to effect of, "Would things be better if I took a drink right now?" The answer "yes" because it's true.

What if you ask a person who has been stuck in the desert for a day and a half with no water, "Would things be better if you took a drink of cat piss (or water if you must be proper ) right now?" They will answer "yes" because it's true.

The whole point of behavior modification is to get people to think in a different way. Sure, in the short term a drink might make things better, but in the long term, it's not a good idea for that person. In the short term the person needs to learn alternative behaviors besides drinking to "make things better."

It seems like some of you have a vision of Bela Lugosi locking himself in his bedroom and chaining himself to the bed because there's a full moon, and he doesn't want to harm anyone when he turns into the wolfman. That's not how it works. In reality the person is affected by a number of influences, biological and environmental, concluding that the best course of action at that moment is to take a drink.

You say very reasonable things every once in a while . . .

We both want to help that person. You want to tell him that he has a disease and that "based on science" you know it's impossible for some to control. I want to tell them that this is a voluntary behavior that they can control but only if they acknowledge their responsibility to control their behavior. Once they accept that, they can look at all of the factors influencing them and tackle them one at a time using whatever means are necessary (medication, rehab, therapy, relocation, etc). Attacking each factor is a choice they have to make.

This is perfectly reasonable as well. It doesn't address the core contention though which is that SOME people are so impaired that they are unable to choose not to drink. Come up with some studies that show that ALL alcoholics can always choose not to drink despite their brain physiology and we'll talk. Put up or shut up, as they say.

 

[Skeptical Greg]

WTF is moderately unable ? !

Is English your first language ?

 

[Gandalfs Beard]

Once again, on what basis do you determine that they are "literally unable" to make those choices? Since you mention jail, there are severe legal implications. If we are jailing people "literally unable" to make lawful choices, then that is clearly wrong in my book. You don't say that "all" people are "literally unable," so how do you differentiate the two? Forget everything I've said and just answer the question. It's extremely important to know how to do this. The implications for the medical community, legal community and society at large are enormous.

Also, please read this post and respond because it deals directly with this issue.

I'll have to read your link at a later point, I am way too tired right now. But in regards to the choice question, with better technology we have more methods available for determining how much a persons ability to choose is compromised.

One is simply the old fashioned way of measuring behaviours. Xjx338 is right to point out that certain patterns of behaviour are so extreme, that in itself is enough to determine a lack of "choice", or perhaps more appropriately, a lack of ability to control compulsive behaviour.

In which case, I agree that anything and everything should be tried to help that person, even if it requires an "intervention."

As our technology becomes increasingly better, whether through finer brain mapping systems, neurological testing, or simply looking for any physiological malfunctions that could affect the frontal lobes, we can determine any number of factors that could be affecting the cognitive ability to control limbic responses.

As to the legal questions, indeed, all of the above is often used in a court of law to determine whether or not a person has volitional control. If the legal representative is competent enough, they can (with medical experts) make a case that such persons be remanded to some sort of treatment center rather than jail. Courts do this for persons with psychotic breaks on a regular basis.

Do you think that someone who has extreme Compulsion issues should be treated any differently? By your statement above, it would seem that you don't. It really makes little difference whether the compulsive behaviour leads to murder or extreme addiction. If one is sent to a psychiatric or neurological clinic for treatment, then so should the other.

Unfortunately many people with incompetent lawyers DO end up in jail instead of the necessary treatment centers.

GB

 

[xjx388]

WTF is moderately unable ? !

Is English your first language ?

No. I started my life a Spanish speaker but learned English early on. Perdóname, maybe I should have said Moderately Unable.

Moderately able = Difficult to choose not to drink, but possible with support.

Totally unable = Cannot make a choice, period.



I notice you post on here and disparage other people's posts (and sometimes agree )but you never put your own position forth. I guess it's easier for you that way, no pesky positions to defend.

 

[Uncayimmy]

I'll have to read your link at a later point, I am way too tired right now. But in regards to the choice question, with better technology we have more methods available for determining how much a persons ability to choose is compromised.

Compromised <> "Literally Unable"

Please address the question.

One is simply the old fashioned way of measuring behaviours. Xjx338 is right to point out that certain patterns of behaviour are so extreme, that in itself is enough to determine a lack of "choice", or perhaps more appropriately, a lack of ability to control compulsive behaviour.

That's a non-answer. You're both resorting to, "Well, since some people don't that must mean they can't. How do we know? Because if they could they would."

Hundreds of posts and not once have any of you been able to explain how to distinguish "literally unable," "impossible" or "lack the functionality" from those you agree are "literally able" and thus for them it's "possible" because they have the "functionality." You just proclaim that such a distinction exists because, well, it just does.

I have decided to change my position. I no longer believe it's choice. I believe that those whom you consider "literally unable" are possessed by demons. Those who are "literally able" are not possessed by demons. Sometimes the demons leave and come back, which explains the relapses. After all, that's truly the traditional diagnosis - it existed for centuries, and no scientist has ever proven it wrong.

 

[Skeptical Greg]

xjx388

I notice you post on here and disparage other people's posts (and sometimes agree )but you never put your own position forth. I guess it's easier for you that way, no pesky positions to defend.

My position can be inferred ..

I find nothing wrong with UY's position, and he defends it well; or at least moderately well, so I have little to add..

These semantic acrobatics ( like ' moderately unable ' ) that you and others employ to skirt the issue of personal responsibility ( choices ) is intriguing at best .

We have 700+ posts arguing about whether or not alcoholics or other substance abusers are able to choose ( easy or hard, notwithstanding ) to partake of an addictive substance.

I think UY may be just as guilty of beating a dead horse as anyone else in this thread ..

 

[xjx388]

I have decided to change my position. I no longer believe it's choice. I believe that those whom you consider "literally unable" are possessed by demons. Those who are "literally able" are not possessed by demons. Sometimes the demons leave and come back, which explains the relapses. After all, that's truly the traditional diagnosis - it existed for centuries, and no scientist has ever proven it wrong.

Finally we find some common ground! I'm glad you came around to -

Oh, wait.

More ridiculousness.

Never mind.

 

[Gandalfs Beard]

Compromised <> "Literally Unable"

Please address the question.


That's a non-answer. You're both resorting to, "Well, since some people don't that must mean they can't. How do we know? Because if they could they would."

Hundreds of posts and not once have any of you been able to explain how to distinguish "literally unable," "impossible" or "lack the functionality" from those you agree are "literally able" and thus for them it's "possible" because they have the "functionality." You just proclaim that such a distinction exists because, well, it just does.

I have decided to change my position. I no longer believe it's choice. I believe that those whom you consider "literally unable" are possessed by demons. Those who are "literally able" are not possessed by demons. Sometimes the demons leave and come back, which explains the relapses. After all, that's truly the traditional diagnosis - it existed for centuries, and no scientist has ever proven it wrong.

I'd almost be willing to call it a draw and be done with this argument. You don't have any evidence to actually back up your assertions that everyone ALWAYS has a "choice".

The only problem with calling a draw, is that there IS evidence that demonstrates variable amounts of "choice" given that not all people have equal physiologies.

The only reason I would even consider calling a draw, is that you and I are both operating with different definitions of "choice." Nor can either of us "Prove" our definitions of choice are the "right" definition.

If we can't even agree on that, there's really no point in us arguing about it any more.

GB

 

[Skeptical Greg]

..........

I have decided to change my position. I no longer believe it's choice. I believe that those whom you consider "literally unable" are possessed by demons. Those who are "literally able" are not possessed by demons. Sometimes the demons leave and come back, which explains the relapses. After all, that's truly the traditional diagnosis - it existed for centuries, and no scientist has ever proven it wrong.

Of course !


" The Devil Made me Do It ! " defense ..

That's the ticket..

 

[Dancing David]

Your position seems to make "choice" seem to be independent of biology, when it is fully dependent on one's biochemical make up. It's almost as if you're presupposing dualism

The ontology of free will is not as yet resolved, I believe that I have constrained free will, when I am untreated and in full blown symptoms, I feel that my freedom of choice is restricted by distorted thinking, anxiety (obsession/compulsion) and the biophysical issues of irritability and disturbed sleep.

I feel perhaps incorrectly that I have free will to a greater extent when I am medicated then when I am not. Free will can be a biological process, not all systems in the brain are equal, some regulate mood, some motor systems, some ‘executive function’, volition could exist in the biological matrix.

 

[Dancing David]

xjx388



My position can be inferred ..

Argument from obscrurity?

I find nothing wrong with UY's position, and he defends it well; or at least moderately well, so I have little to add..

These semantic acrobatics ( like ' moderately unable ' ) that you and others employ to skirt the issue of personal responsibility ( choices ) is intriguing at best .

We have 700+ posts arguing about whether or not alcoholics or other substance abusers are able to choose ( easy or hard, notwithstanding ) to partake of an addictive substance.

I think UY may be just as guilty of beating a dead horse as anyone else in this thread ..

I notice that you could choose to actually participate in the discussion, yet you seem to just want to add nothing to the conversation.

Choice?

You haven't given why you feel at this point that choice is not constrained in some circumstances, such as diminished intellectual capacity or neurological issues with impulse control, so you picking on what you consider to be semantic juggling is merely pedantry.

 

[Gandalfs Beard]

The ontology of free will is not as yet resolved, I believe that I have constrained free will, when I am untreated and in full blown symptoms, I feel that my freedom of choice is restricted by distorted thinking, anxiety (obsession/compulsion) and the biophysical issues of irritability and disturbed sleep.

I feel perhaps incorrectly that I have free will to a greater extent when I am medicated then when I am not. Free will can be a biological process, not all systems in the brain are equal, some regulate mood, some motor systems, some ‘executive function’, volition could exist in the biological matrix.

Well Said.

GB