Is Alcoholism a Disease?

"Alcoholism Disease Concept" Alcoholics have an involuntary disability to control their desire for alcohol, their initial consumption of alcohol and the amount of alcohol they do consume once they start drinking. It represents the sum of all the abnormal drinking displayed by all alcohol beverage consumers. These abnormal drinkers are characterized by continuous or periodic: impaired control over their alcohol drinking, preoccupation with alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial by which these individuals differ from the norm, and which places them at a significant disadvantage.

One of the great controversies in respect of treatment of alcohol problems is the debate over whether or not alcoholism is a disease. There is little doubt that regarding alcoholism as a disease, rather than as a moral weakness, has brought benefits to alcoholics/addicts. To some extent it reduced the stigma experienced by sufferers and has opened the door to alcohol treatment and rehabilitation rather than punishment. It is the mainstay of the belief system of AA and NA groups who have been responsible for helping many to recover from a hopeless state. However there are many critics of the disease model, both on the grounds that there is little evidence to support it and that it may in fact be detrimental to recovery.

Far from supporting the model, much of the evidence that has been produced is in direct opposition to it. For example a famous study of alcoholics (Mendelson and Mello 1978) found that alcoholics could and did control their craving and consumption. In this experiment they were given the opportunity to work in exchange for alcohol and to consume it when and as they wanted. Instead of being constantly drunk, it was found that the subjects worked and consumed alcohol selectively, sometimes saving some for consumption at a later time. Other studies have found that alcoholics (both treated and untreated) have returned to patterns of problem free consumption. These people are in the minority but they do nevertheless represent a significant number. Finally a new topic in addiction research is what is known as natural recovery, that is changing addictive behavior without the aid of treatment. Many studies have found that this is a common route out of addiction. Indeed one large scale study found that not only is it common, it is by far the most common route. All of these findings undermine the validity of the disease model. Even the seminal work of Jellinek, which described the disease model originally, was based on work carried out entirely with members of AA. Hence he was describing a particular type of alcoholic (the typical AA member) and there may be many different types of alcoholics/addicts for whom these symptoms do not apply. AA members often point to the “Doctor’s opinion” written by Dr. Silkworth in 1939, who discusses alcoholism as an allergy. However, it begs the question, if these same people were to attend their Doctor with a different condition and a journal written in 1939 was used as the definitive text, would they be quite so happy to accept this Doctor’s opinion. I suspect a second opinion, or more likely a different doctor, would be sought rapidly.

In respect of alcohol treatment, the current view is that, in the disease model the alcoholic and drug addict is portrayed as someone who has no control over his or her behavior and hence requires addiction treatment to recover. This is often viewed as engendering feelings of helplessness and encouraging an abnegation of responsibility. In contrast the current view of addiction treatment is that in order for recovery to occur the client needs to take full responsibility for his or her behavior and to be motivated and inspired to change their self destructive tendencies. Moreover rather than enforced abstinence the client should be offered a choice of possible outcomes (i.e. abstinence, reduction in consumption or controlled drinking), so the client is made to feel greater ownership of his or her recovery from alcohol and drug addiction and is then more motivated to succeed. Interestingly the research suggests that most subjects given a choice of outcomes still end up abstinent, however having a ‘choice’ of outcomes has the effect of increasing motivation.

While the disease model has had some benefits by initially introducing treatment for alcoholics/addicts, ironically it is now viewed by many modern commentators as being detrimental to alcoholism treatment. Many of the concepts of the disease model have been found to be fallacious and indeed explainable by other mechanisms. Nevertheless it continues to be the mainstay of AA and NA and provides benefits for its millions of members.

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