Disease Model Of Alcoholism
Is Alcoholism A Disease?
Some support the disease model of alcoholism, others say alcoholism is not a disease. Who is right?
The disease model of alcoholism is as contentious a topic as you can get in addiction studies. It goes to the very heart of what alcoholism is.
Some of the reasons why the disease model of alcoholism are so hotly debated are:
- If alcoholism is a disease, then it is a medical condition. This means that insurance companies will pay for its treatment.
- The disease status also means that those who suffer from the condition are 'powerless' over their illness. They are stripped of the responsibility to deal with it.
- If alcoholism isn't a disease and is a matter of choice then the alcoholic can stop drinking or return to moderate drinking through his or her own actions. He or she is not powerless.
Unsurprisingly, there are two points of view on this issue.
One view is that alcoholism is a disease
and it should be treated as such.
The other view, not surprisingly, believes alcoholism is not a disease
and should be treated as such.
Alcoholism is a Disease
|The NCADD states,
'Alcoholism is a primary chronic disease with
genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug...use of alcohol despite adverse consequences and distortions in thinking, mostly denial. Each of these symptoms may be continuous or episodic.'
What the NCADD, that is the National Council on Alcoholism and Drug Dependence, is saying here is that, yes, alcoholism is a disease.
This view of alcoholism as a disease is also held by 90% of the American public (according to a Gallup poll).
It is also advocated by many professional organizations such as the AMA
(American Medical Association), WHO
(the World Health Organization), APA
(American Psychiatric Association) and countless others.
Those who hold this idea believe that the alcoholism disease is....
- ...a primary, chronic and sometimes fatal disease.
- ...progressive. This means that alcoholism starts relatively innocently much like moderate drinking e.g. a few drinks at the weekend. Then it gradually worsens and progresses until the sufferer is a full-blown alcoholic. The disease hypothesis states there are three alcoholism stages.
- ...a 'mental obsession that causes a physical compulsion to drink.' Many drink addicts talk of having 'a monkey on their back'. This monkey is constantly at them, urging them to pick up the next drink from the moment they wake up to the moment they sleep. The only way to get the monkey to shut up is to have that drink and then another and then...you know the story. It is an intense craving that never leaves the sufferer.
- ...a disease of the brain. Drinking alters its functioning. It is known as alcoholic brain.
- ...a biopsychosocial disease.
- ...no different from other chronic diseases like diabetes. It has be managed throughout the life of the sufferer.
- ...has signs and symptoms like any other disease.
- ...50-60% of the time caused by genetic factors and 40-50% of the time by environmental ones.
- ...with the sufferer from birth. Alcoholics Anonymous which brought the alcoholism disease concept to the attention of the public state that alcoholics are a special group of people. They cannot control their drinking. They have an alcohol allergy.
- ...a cause of shame for many. If it is labeled a disease then those suffering from it are more likely to seek help.
As stated above the belief that alcoholism is a disease is the prevalent view in the addiction treatment community
. Alcoholics Anonymous
and the alcoholism rehabilitation industry base their treatment methods around the concept.
In recent years the debate has grown and there are more and more disputing the alcoholism disease model. Stanton Peele
(a social/clinical psychologist) is a vociferous opponent of the disease concept on the web. Many AA alternatives
have sprung up and there have been advances in alcoholism medication
Alcoholism is not a Disease
This view states the the disease concept of alcoholism is wrong and calling it a disease strips the abuser of any responsibility for their drinking.
Other arguments against classifying it as such are............
- Dr. Benjamin Rush, who in the 1800s was the first to claim alcoholism was a disease, also claimed that being of African American descent was also a disease!
- One of the early founders of AA, whose program is based around the disease concept, was Marty Mann. She with the findings of a scientist E.M. Jellinek popularized this hypothesis. Apparently they were both funded by a certain Smithers, founder of the NIAA (National Institute for Alcoholism and Alcohol Abuse). Smithers was not working from selfless motives, he had his own treatment program he was trying to get off the ground. Having alcoholism labeled as a disease enabled him to make a lot of money.
- Once you label somebody as having 'the alcoholism disease' then they will conform to it. e.g. adopt the signs and symptoms associated with drink addiction. It is self-fulfilling.
- The signs of alcoholism are vague and not measurable. Other chronic, manageable diseases such as diabetes have symptoms that can be objectively measured (e.g. blood sugar level etc.). Alcoholism has symptoms such as increased tolerance for alcohol over time - how is this calculated? It relies on information from the user. Subjective not objective.
- Calling alcoholism a disease is just another example of the increase in medicalizing life's problems. It benefits nobody except pharmaceutical companies and, in our case, the industry that has grown up around alcohol addiction recovery industry.
- Labeling alcohol abusers as suffering from a 'disease' strips them of all responsibility and, in all likelihood, makes their drinking worse. They see themselves as powerless- a disease cannot be cured by force of will- and at the mercy of their so-called illness.
This debate looks like it's going to rage on and that a compromise is unlikely.
What is certain, however, is that the once dominant position of the disease model of alcoholism in the addiction treatment industry seems to be losing ground.
There are many alternatives to the idea of alcoholism as disease for people who believe that alcoholism is something that can be defeated by the individual using his or her own resources
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