Is Alcoholism Really a "Disease"?

I tend to think that it is. I've seen too many people who just can't control their drinking while others can just walk away. What's the difference? I don't think things like 'character' or 'willpower' explains it.

Granted, some folks with the disease can control it through force of will. Others can't, and it's a sad thing to see.

 

I actually did alcoholism research for several years. It is definitely a disease and really quite interesting. One feature you might appreciate is that most alcoholics are actually very controlling personalities. It is very difficult for them to admit that this drug, and it is a drug, has a hold on them. They have difficulty dealing with this which just leads to more drinking! They can' t appreciate the fact that the drug alters their perceptions.

To me one of the most compelling evidence that this is a disease comes from the facts that 1) it does seem to run in families and it isn't a psychosocial phenomenon and 2) alcoholics have a lot of behaviors that are common. They're strange behaviors like saving their empties. Go to an ALANON meeting some time and you'll really be amazed at the commonality of events suffered by those living with alcoholics. ALANON isn't AA, it is the group for family and friends of alcoholics, just in case someone hasn't heard of it.

 

Doesn't there have to be a pathological aspect to alcoholism for it to qualify as a disease? One of the last medical statements that I'd heard on the subject said that the only real difference between an alcoholic and a nonalcoholic is that an alcoholic drinks a lot of alcohol. I believe that we need our medical people to rule on this one.

 

The medical community has ruled on it and it is classified as a disease. There also is serious pathology associated with alcoholism. It is secondary to the toxic effects of the drug, eg. liver disease. By the way, I'm a toxicologist...

 

I see. And just what is that serious pathology that is unique to alcoholics? Liver disease in and of itself is not unique to alcoholics is it?

 

The syndrome itself is unique to alcoholics. You brought up pathology, not me. The pathology associated with alcoholism is secondary to the toxic effects of the drug. Actually cirhosis of the liver due to causes other than alcohol is not all that common. There are also cariomyopathies that are associated with alcoholism as well as coagulopathies. What you're probably hoping for is that someone can say that there is a particular brain lesion associated with the disease. Not all diseases manifest that way. Alcoholism is more akin to a metabolic disease. These people have an altered brain chemistry in the presence of alcohol, a "genetic polymorphism". Another example would be people who are perfectly normal but if they take aspirin, it can be fatal.

 

A disease is normally thought of as something that is infectious, such as bacteria, fungi or bacteria. Alcohol is not an infection, but must be directly ingested by an individual. An individual may have a genetic predisposition to being sensitive to alcohol and other substances, generally referred to as an "addictive personality." Prolonged use often produces a tolerance effect, meaning an individual requires more of a substance to produce the same or greater effect.

We may call alcoholism a "disease" to meet the criteria for medical billing and reimbursement, but alcohol is not infectious, and is not communicable from one person to another.

 

I know that I brought up pathology because I want to know what it is that is pathologically unique to alcoholics but don't put words in to my mouth. What I AM hoping for is a clear definition of what pathological aspects are unique to alcoholics; brain lesion wasn't something that I was "hoping" for specifically. Why don't you explain the terms "cariomyopathies" and "coagulopathies", the specific ones you're referring to and confirm that they are unique to alcoholics. I'm also curious why you got so defensive. My opinion ever since I first heard alcoholism classified as a disease has been that it just makes it easier for alcoholics to claim that they can't help themselves because they have a disease. I'm just looking for real, factual information that disproves that opinion.

 

Good answer. Smoking isn't a disease but it causes diseases. Alcohol is not a disease but it causes diseases. Is that an accurate comparison?

 

Can we agree that if a person can't stop drinking alchohol it could be thought of as a disease? Does the language really matter that much? I've known several people that couldn't stop drinking no matter how hard they tried. I had a very hard time quitting cigarettes, but never had any problems with booze.

I believe it is a disease.

 

Know what Squidy? You're right.

Nobody points a Glock to your head and *forces* you to drink till you puke. Nobody forces a kid to start smoking.

Nobody forces a punk street racer to drive 120 km/h down Portage Avenue here in Winnipeg - a posted 60 km/h zone - and mow down a woman crossing with a bag of groceries. Then nobody "forces" that dumb-nice person punk to claim he was innocent and that the pedestrian was at fault for not looking.

Nobody "forces" a semi-illiterate redneck in a jacked-up Chevy pickup to kill somebody in a road rage crash.

Nobody "forces" a sportbike owner to rocket through traffic until he slides off, breaks his back, and expects the general public to pay for disability for the rest of his natural life.

What I see is a huge problem with Addictive Personalities and a Risk Subculture. So whether you get your kicks by smoking 2 packs a day, drinking til you puke and s*** your pants, driving aggressively, or whatever, you have a PROBLEM.

I have a lot of sympathy for folks who are addicted to those sort of risky activities, and I think they should receive the professional help they need. That doesn't mean I should have to pay for the damage they cause.

 

Who says a disease has to be caused by an infection? Here is the definition from the OED

A condition of the body, or of some part or organ of the body, in which its functions are disturbed or deranged; a morbid physical condition; ‘a departure from the state of health, especially when caused by structural change’ (Syd. Soc. Lex.).

Depression is certainly a disease, but it is not caused by any infectious agent.

 

A disease does not have to be communicable for it to be a disease. m-w.com says:

disease
2 : a condition of the living animal or plant body or of one of its parts that impairs normal functioning

I would argue that alcoholism impairs normal functioning. And, I've read some things that say there's a genetic connection. For example, there's a much higher incidence of alcoholism in Native Americans than in European Americans. Now, some may argue that this is a "nurture" rather than "nature" thing (i.e. you're exposed to more alcoholics in your community, so you think it's "OK"), but I seem to recall reading that this has been debunked. Anyone have more specific information?

 

Seems like everything someone can do that someone else doesn't like can be a disease, but at that point do we show the same concern for everything or just the stuff that's fashionable?...

 

alcohol dehydrogenase, the enzyme that metabolizes alcohol, has been shown to differ in some populations- can be less effective.

there's an aspect of refusal to help oneself once you reach the point where your problem can be defined as alcoholism. there's a desire to blame it on someone/something else.

however, the biochemistry is there that makes these people different.

all biomedical crap aside... is alcoholism a disease? ask anyone who grew up with an alcoholic. the answer will be a resounding "yes"

 

I don't know, I still haven't read anything that suggests that there's anything pathological that is unique to alcoholism. I know at least one person who's parents were both alcoholic and she's chosen not to be one. That tends to disprove the genetic theory. As Squid alluded to, there's no condition that forces your hands to pour the drink down your throat.

 

So what?

Lots of diseases are genetic and many are not communicable.
Arthritis, Schizophrenia, cancer, heart disease, hyper-thyroidism, etc

 

Infectious disease is a very small total of all diseases. Imagine how many Infectious disease specialists there are compared to oncologist, cardiologists, etc. Cancer, Heart Disease, MS, ALS, none are infectious but certainly are diseases.

Addictions compare better to mental illness. Somene with schizophrenia may choose NOT to take medication, and have their symptoms return. Someone with addiction may choose to use again, and have their symptoms return. It's hard to imagine since we believe in personal responsibility and choices, the problem is someone with mental illness or addiction isn't thinking the logical way we expect.

 

I think there's a lot we DON'T KNOW yet about why many individuals are "addicted" to different substances---and how inherently addictive some substances that are commonly reputed to be "addictive" really are---and why some groups of people who may or may not have inherited traits other than their "ethnicity" seem to be more susceptible to heavy use of some of the substances (e.g., Russians, Irish, some "Native American" tribes).

One thing that IS known is that there's a well-established process, controlled by a self-interested group called the American Medical Association, through which "sufferers" who exhibit certain kinds of behavior can get their behaviors "officially" declared a "disease". We've seen the process at work in the cases of drugs and alcohol. More recently, we've seen it at work with so-called Attention Deficit Disorder, the "diseasification" of which has now resulted in thousands of doctors writing millions of prescriptions for medicines which are now routinely dispensed through our public schools.

A case in point about the "politics" of this process is the ongoing struggle of hundreds of thousands of people to get a "condition" known commonly as "chronic fatigue syndrome" declared an "official" disease. I was personally involved in this effort for a while about 25 years ago, thinking at the time that I was one of the disease's "victims".

I don't want to step on anyone's toes here, so I'm choosing an example where I was myself a "supplicant".

The pressures for a rush to judgement in all these cases, regardless of the indisputable facts at hand (or paucity thereof), are well-known, urgent and powerful. The psychiatric "profession" has its own parallel process.