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Is Alcoholism Really a Disease?

This article is not written to help diagnose or treat alcoholism, please speak to a health care professional for a treatment plan. The statements made in this article are opinions of the writer.

Introduction to this article

There are many variables that one must consider when discussing this topic. First one must take into account the current scientific information available. Then one must take into account the many different levels of alcoholism. Not one treatment plan will work for every alcoholic, and not one opinion can address every factor of alcoholism. I am limited to the current information I have, and my opinions are subject to change as more information becomes available to me.

You may find that the layout of this article is not your typical format. The main reason I have done this is because I want you to be able to come to your own conclusions before reading mine. It will be interesting to see how different people use the same information to form different opinions. I have also chosen this format to intentionally lose the interest of anyone who is not serious in this discussion. "Why would I do that?" Alcoholism is a serious condition, disease or not, and I don't want my opinions to be read by anyone who is not ready to invest as much time in researching the information as I have. "Man! That's harsh!"; no it's not. We are potentially talking about life or death. I find that my opinions could be detrimental to someone new to recovery. If someone new in recovery reads this, they may do so with selective vision. I find this format allows for those who are ready to read it all, in it's entirety, a great resource of information. And those who aren't ready will become bored with this format. I hope those of you who do read it enjoy it and gain some information along the way.

I want to start off by providing you the information currently available to me, before I inject my opinions. I will use the material to explain how I came to my conclusions.

What is a disease?

"A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, "disease" is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, and/or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections. Isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. A diseased body is quite often not only because of some dysfunction of a particular organ but can also be because of a state of mind of the affected person who is not at ease with a particular state of its body."

" Death due to disease is called death by natural causes. There are four main types of disease: pathogenic disease, deficiency disease, hereditary disease, and physiological disease." [1]

"An abnormal process affecting the structure or function of a part, organ or system of the body. It is typically manifested by signs and symptoms, but the aetiology may or may not be known. Disease is a response to a specific infective agent (a microorganism or a poison), to environmental factors (e.g. malnutrition, injury, industrial hazards), to congenital or hereditary defects, or to a combination of all these factors. Note: illness is sometimes used as a synonym of disease, but it also refers to a person's perception of their health, regardless of whether the person does or does not have a disease." [2]

What is alcoholism?

"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 continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial." [3]

"Physical dependence on alcohol to the extent that stopping alcohol use will bring on withdrawal symptoms. In popular and therapeutic parlance, the term may also be used to refer to ingrained drinking habits that cause health or social problems. Treatment requires first ending the physical dependence, then making lifestyle changes that help the individual avoid relapse. In some cases, medication or hospitalization are needed. Alcohol dependence can have many serious effects on the brain, liver, and other organs of the body." [4]

The four stages of alcoholism

"An individual passes through several phases prior to the last stage of addiction or dependence. The four stages of alcoholism are pre-alcoholic, prodromal, crucial and chronic. (See source for a complete description of each phase.)" [5]

What are the symptoms of alcoholism?

Being unable to limit the amount of alcohol you drink
Feeling a strong need or compulsion to drink
Developing tolerance to alcohol so that you need an increasing amounts to feel its effects
Having legal problems or problems with relationships, employment or finances due to drinking
Drinking alone or in secret
Experiencing physical withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink
Not remembering conversations or commitments, sometimes referred to as "blacking out"
Making a ritual of having drinks at certain times and becoming annoyed when this ritual is disturbed or questioned
Losing interest in activities and hobbies that used to bring you pleasure
Irritability when your usual drinking time nears, especially if alcohol isn't available
Keeping alcohol in unlikely places at home, at work or in your car
Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel "normal" [6]

Biological factors for alcoholism being a disease

Alcoholics have a decreased level of D2 receptors which means less dopamine absorption in key control centers of the brain making it harder to experience pleasure, fight depression, battle negative circumstances, and control inhibitions.
Alcoholics seem to metabolize alcohol differently than non-alcoholics.
In addition to the decreased level of D2 receptors, several factors involved in brain function seem to exist in alcoholics that do not exist in non-alcoholics, including a deficiency in the transmission of serotonin and a smaller than normal amygdala.
These biological traits can run in families.[7]

The social aspect of addiction

The Rat Park experiments

Quote from: Like90

"In a nutshell, rats in crappy conditions self-administered opiates via a lever (same as the food-providing lever in many other types of behavioural experiments) but when the rats were moved to healthy conditions, they chose drug-free water even though they still had the choice of opiated water. They literally weaned themselves off the addictive drug when their environment was improved. Just fascinating stuff." [8]

Long term consequences of child abuse

"Alcohol and other drug abuse. Research consistently reflects an increased likelihood that abused and neglected children will smoke cigarettes, abuse alcohol, or take illicit drugs during their lifetime (Dube et al., 2001). According to a report from the National Institute on Drug Abuse, as many as two-thirds of people in drug treatment programs reported being abused as children (Swan, 1998)." [9]

Violence Preceding Alcohol Misuse

Childhood Victimization.

"A history of childhood sexual abuse (16) or neglect (17) is more likely among women with alcohol problems than among women without alcohol problems. Widom and colleagues (17) found no relationship between childhood victimization and subsequent alcohol misuse in men. Even children who only witness family violence may learn to imitate the roles of aggressors or victims, setting the stage for alcohol abuse and violence to persist over generations (18). Finally, obstetric complications that damage the nervous system at birth, combined with subsequent parental neglect such as might occur in an alcoholic family, may predispose one to violence, crime, and other behavioral problems by age 18 (19,20)." [10]

Violent Lifestyles

"Violence may precede alcohol misuse in offenders as well as victims. For example, violent people may be more likely than nonviolent people to select or encounter social situations and subcultures that encourage heavy drinking (21). In summary, violence may contribute to alcohol consumption, which in turn may perpetuate violence." [10]

Learned behaviors

"Other experts disagree with the analogy between substance abuse and physical disease. They believe that addictive behaviors can be better understood as problematic habits or behavior patterns that have been learned in accordance with the principles that guide all learning. To these experts, addictive behaviors are maladaptive habits and behavior patterns that can be "unlearned" and replaced with new, alternative, more healthful behaviors. According to learning theorists, one's past and present experiences, environment, family history, peer group influences, and individual beliefs and expectations, determine who will or will not become addicted to a substance or behavior." [11]

Common Causes for Alcohol Misuse and Violence

"In many cases, abuse of alcohol and a propensity to violence may stem from a common cause (22). This cause may be a temperamental trait, such as a risk-seeking personality, or a social environment (e.g., delinquent peers or lack of parental supervision) that encourages or contributes to deviant behavior (21)."

"Another example of a common cause relates to the frequent co-occurrence of antisocial personality disorder (ASPD) and early-onset (i.e., type II) alcoholism (23). ASPD is a psychiatric disorder characterized by a disregard for the rights of others, often manifested as a violent or criminal lifestyle. Type II alcoholism is characterized by high heritability from father to son; early onset of alcoholism (often during adolescence); and antisocial, sometimes violent, behavioral traits (24). Type II alcoholics and persons with ASPD overlap in their tendency to violence and excessive alcohol consumption and may share a genetic basis (23)" [12]

I now want to take a look at a few theories and fallacies that can be applied to alcoholism, but we must first understand these theories and fallacies

Theory on cause and effect

What is causality?

"(in research) a relationship between one phenomenon or event (A) and another (B) in which A precedes and causes B. The direction of influence and the nature of the effect are predictable and reproducible and may be empirically observed. Causality is difficult to prove. Some social scientists contend that it is impossible to prove a causal relationship. Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier."
"in a relationship between one event or action that precedes and initiates a second action or influences the direction, nature, or force of a second action. In scientific study, causality must be observable, predictable, and reproducible and thus is difficult to prove. Mosby's Dental Dictionary, 2nd edition. © 2008 Elsevier, Inc. All rights reserved."
"the relationship between cause and effects. principle of causality: the postulate that every phenomenon has a cause or causes, i.e. that events do not occur at random but in accordance with physical laws so that, in principle, causes can be found for each effect. Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved" [13]

Chicken or the egg?

" The chicken or the egg causality dilemma is commonly stated as "which came first, the chicken or the egg?" To ancient philosophers, the question about the first chicken or egg also evoked the questions of how life and the universe in general began."

"Cultural references to the chicken and egg intend to point out the futility of identifying the first case of a circular cause and consequence. It could be considered that in this approach lies the most fundamental nature of the question. A literal answer is somewhat obvious, as egg-laying species pre-date the existence of chickens. However, the metaphorical view sets a metaphysical ground to the dilemma. To better understand its metaphorical meaning, the question could be reformulated as: "Which came first, X that can't come without Y, or Y that can't come without X?" [14]

Research

The Causal Relationship between Socioeconomic Factors and Alcohol Consumption:

A Granger-Causality Time Series Analysis, 1950-1993 Journal article by Garland L. Brinkley; Journal of Studies on Alcohol, Vol. 60, 1999 (Do not have access to the full article.)

"Some researchers have offered explanations related not to specific identifiers but to broader panoramic forces that sweep the country. Room (1987, 1989), for example, describes a long-wave alcohol consumption pattern that runs across generations, each generation alternating between high and low consumption. Room speculates that the generation following a high consumption generation will have low consumption as a result of witnessing the detrimental effects of alcohol. A generation that follows a low consumption generation will have high consumption since little or no detrimental effects of alcohol were observed. The wave flows across two generations and then repeats. Room's explanation highlights the need and importance for incorporating a time component when considering changes in alcohol consumption." [15]

One of the hardest things to debate while discussing this topic is the definition of a disease. We may all never agree on what the definition of a disease is. The official definitions are wide and varying depending on your source. But hopefully this article will address enough information that agreement on the definition won't be needed.

One thing that we should look at is the alcoholics perception of his/hers condition. We can do this by examining the internal and external Locus of Control:

[16]

Someone with an external locus of control may consider their alcoholism a disease, while someone with an internal locus of control may not consider their alcoholism a disease. Let's examine how these two would come to their conclusions.

Let's start off by looking at "Tom". Tom has an external locus of control. His family has a history of alcoholism, and he believes it's hereditary. He blames his traumatic childhood on alcoholism, and he also suffers from depression. He feels that, due to his genetics, he had a predisposition to become an alcoholic.

Now let's look at "Tim", Tim has an internal locus of control. His family has a history of alcoholism, and he believes it's a learned behavior. He too had a traumatic childhood, but he doesn't blame it on alcoholism, he blames it on the individual who caused him the pain. He acknowledges that his depression's source could be either genetic or a byproduct of being born in to a family with a history of alcoholism. Tim doesn't believe he had a predisposition to become an alcoholic, but acknowledges that his actions brought him to his current state of addiction.

You may be wondering, “Why does it matter?”. While Tom is blaming his condition on the inevitable, Tim can work on addressing the issues that brought him to his current state. Tom is powerless, and Tim has power.

When discussing the internal and external locus of control, I don't mean to imply any absolutes. I don't think either Tim or Tom is more prone to alcoholism , or that either will have no chance of recovery.

Through my research have I learned that it is good to find a balance of both an internal and external locus of control, depending on the situation and variables. I don't believe that one can have a balanced psyche with out being able to obtain both locus of controls.

Our personalities are developed by external factors, such as the social conditions I mentioned. But when examining those social conditions, we have to decide what we can control internally and externally.

Take child abuse, for example. As a child you have little to no control over the circumstances you are in. But as an adult you do have control over what that past abuse does to your psyche. As a child Tim or Tom may have tried to gain control by talking to another family member hoping they would help, wearing short shorts hoping a teacher would notice the markings, or telling friends hoping they would report it to anyone who would help. But at the end of the day they had no way to physically stop the abuser. When examining this it's important to realize that neither Tim nor Tom could control the external conditions. So they may have attempted to develop internal coping skills.

What tends to happen when you have external circumstances that you can't control is you often develop internal coping skills that are more of a band aid than a real coping skill. The reason we usually pick a band aid over true coping skill is because we need a quick fix and/or haven't learned how to develop healthy coping skills due to our environment, such as alcoholic parents. In this case we are assuming that both Tim and Tom decided to use alcohol to cope. Drinking temporarily relieves the pain of external factors. But the alcohol only adds another external factor that will have to be addressed when abusing alcohol.

As an adult, if you don't take personal responsibility and develop an internal locus of control to deal with the external conditions, you can not overcome those traumas. They will literally eat you alive. Such as thinking it's your fault the abuser hurt you. Which leads to self blame for something you could not control. If your psyche is in the mind frame of self blame you will continue to develop more self defeating coping skills.

IMO the only way to stop these self defeating coping skills is to compartmentalize what is internal and what is external. Once you realize you can't control the external conditions, you can begin working on treating the internal conditions.

Neither locus of control makes it more or less of a disease. It only affects the symptoms of the alcoholic condition and how the alcoholic progresses into each stage of alcoholism.

When observing how Tim and Tom determine whether or not it's a disease, we can see how the label of "disease" can be self defeating. But the internal and external locus of controls don't confirm or deny whether or not it is a disease. It does, however, address that the way we interpret external conditions weighs heavily on our path to recovery, and decisions we make.

For the sake of this article, let's all agree that there are preexisting biological conditions that can contribute to someone becoming an alcoholic. At what point do these preexisting conditions become a disease? If you never take a drink of alcohol, but have a biological predisposition, do you have a disease? This brings us to a causality dilemma similar to the chicken or the egg dilemma. How do you define which is the cause and which is the effect?

Examples:

Biological predisposition or the action of taking a drink? (See Biological factors for alcoholism being a disease) Learned behavior from being raised by an alcoholic or a biological predisposition? (See The social aspect of addiction) Is the depression the cause of the alcoholism, or is it a side affect of the alcoholism?

It is common knowledge that alcohol is a depressant. So, if you also suffer from a chemical imbalance that causes depression, drinking will only make your mental condition worse. If you aren't being treated for your chemical imbalance, then you may attempt to escape from your depression by drinking. The initial buzz of alcohol can make you feel better, but the long term side effects only make the depression worse.

Some history on how alcoholism became labeled a disease

"The idea of alcoholism as a progressive disease based on the logical fallacy of "post hoc". Bill Wilson observed that all the alcoholics suffering from major withdrawal syndrome had at one point been recreational drinkers. He therefore falsely assumed that recreational intoxication inexorably led to major withdrawal syndrome." [17]

"Despite the common acceptance of drinking in our culture, the destructiveness of alcohol cannot be ignored. “In 1944, the U.S. Public Health Service labeled alcoholism the nation’s fourth largest public health problem, although little governmental action was immediately forthcoming to deal with this area.” (Lender 189) In 1952, E.M. Jellinek supported the view of alcoholism as a disease with “a symptomatic progression of phases leading eventually from psychological to physical addiction.” (Lender 186) In 1956 the American Medical Association recognized alcoholism as a disease. These acknowledgments began the breakdown of some of the stigmas associated with alcoholism. The condition was not a result of immorality or lack of discipline but was a disease." [18]

Now, I do agree that alcoholism progresses into stages (See the four stages listed above). The more you consume, the more often you consume, and the more it will affect your body and life. But the same can be said, if you don't consume more or more often, your alcoholism will not progress. The underlying condition causing the alcoholic to want to drink may progress, but the alcoholism can not progress unless the alcoholic drinks. This is a prime example of why alcoholism is not a disease.

I still agree that alcoholism is not a moral condition or lack of discipline. The stigmata that existed previously prevented alcoholics from receiving help. But the new stigmata of alcoholism being a disease prevents the alcoholic from having power over their condition. Ultimately the alcoholic makes a choice to drink or not to drink. While the temptation, or physical craving, may exist, neither makes the alcoholic consume alcohol.

The very idea that alcoholism is a disease of powerlessness creates a catch 22. It turns the alcoholic in to a victim of a disease, it makes it inevitable that they would become an alcoholic regardless of a biological or social condition.

In most cases a biological or social condition can be addressed, limiting the desire to drink. After an extended amount of sobriety, the body will no longer physically crave alcohol. But yet, even once sober, does the alcoholic have a disease? That doesn't make any sense! They say it can't be cured, but if you are sober, how exactly is it not cured? Because you will drink again? Why will you drink again? Because you choose to? What, and at what point, makes someone drink alcoholically? Can an alcoholic drink again without drinking alcoholically?

Once the physical aspect of alcoholism is addressed, and the alcoholic becomes sober, they must determine what the underlying condition of the alcoholism was. Was it a biological condition, a social condition, or a mix of both? Which ever the situation may be, the alcoholic needs to seek out help to determine their next step. It may be resolved as easily as attending a support group. It may require seeing a psychiatrist, or it may require cognitive therapy. Once the biological or social condition is addressed the mental addiction will fade. Creating a healthier psyche will relieve the alcoholic of their "disease". Now this requires constant monitoring and evaluation. Once someone drinks alcoholically, I don't believe they can ignore that they have developed a poor coping skill. As they say, "Old habits die hard.". When things get hard, life throws you a curve ball, it will be easier to go back to the old habit, the bottle. But more importantly, it will easier to abuse alcohol.

I don't believe that it is impossible to control your drinking if you are not using it as a scape goat, avoidance technique, or a coping mechanism. This is why I say you have to constantly monitor your mental condition. You have to ask yourself a few questions before you drink:

Do I want to drink to avoid a situation that I'm having a hard time dealing with?
Will drinking affect any medicines that I'm currently taking?
Will drinking affect any chemical imbalances that I have?
Can I stop before becoming inebriated?
Am I going to drink and drive?
Do I have a designated driver?
Am I going to spend more money that I can afford?
Will drinking affect any medical conditions that I have? (Such as GI related problems from previous alcohol abuse. Or diabetes)

I am not saying that every alcoholic will be able to drink again, in fact many may not. But it's not because they have a disease, it's because it is not best for them to do so. But there are some people who were once labeled an alcoholic, who can manage drinking again if they proactively take care of their psyche and body. But if in doubt, don't drink. At the end of the day we are responsible for our lives, bodies, and mind. We control what path we take in life, and we have to live the consequences of our actions.

Summary

In short, in order for one to consider alcoholism a disease, one must ignore all biological and social conditions. One must also ignore numerous logical fallacies. I believe alcoholism is a psychological affect of an underlying issue. It may be a biological or social condition, any mixture of the the two, or a simple flaw in decision making. Regardless of why one drinks alcoholically, I think it is very important to seek help, understand that you do have control of your actions, and take a stand to change your life.

Personal Note

I could not have come to these conclusions without many years of research and personal experience. But most importantly my path to atheism made me realize that there is a lot of things we see through rose colored glasses. Through all my years of research, I have never found one compelling argument for alcoholism being a disease that could not be debunked with any of the sources I've mentioned.

Growing up, I was raised to never question many things. It is the theistic way of thinking. It takes out personal accountability, and leaves things up to chance and inevitability. It's especially hard to understand alcoholism when you think God has predestined you to this "disease". As if somehow your family was cursed with this illness for sins that happened generations before you. This is simply not the case.

It's been my experience that there is always a better solution or answer if one takes the time to research something thoroughly. Which again, is why I said my opinions are subject to change. I will never quit studying this topic, it's something that intrigues me, and if one day I find proof to the contrary of my realizations, then I will explore new ideas.

Sources

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