is alcoholism a disease?

[naegleria brain]

here's a question for all of you.

please don't cite what the medical establishment holds as its official stance. just think for yourself.

i'm not asserting that alcoholics are inherently awful people (the abusive ones are) or they should be eradicated or anything of the sort.

but is it a disease when the cure lies within yourself? what about smoking? does a disease have to be defined by physical symptoms (ie withdrawal, delirium tremens), and if so, does that make panting after running a kind of pathology?

or is it a generalized helplessness detrimental to one's health that makes a disease a true pathology?

these are all just example questions worth mulling over; i'd love to hear all of your thoughts.

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[DocBR]

Ohhhhh... This will be interesting.

I think alcoholism is not a disease, nor is it simply a bad lifestyle choice.

My father was an alcoholic and the son of an alcoholic. I fully believe there is a heritable component to addiction (and thus why I hardly ever drink) but that component does not necessarily lead to addiction, there must be a series of bad choices along the way.

I believe at some point, you realize you are headed in a very bad direction, and must choose to continue or change - this very point is what distinguishes alcoholism/90% of obesity cases/drug addiction/etc from a true disease IMO.

Alcoholism is a combination of bad choices, circumstance and potential genetic components, but it is not a disease.


As a side note, have you seen the new commercials where they are advertising a stop smoking drug? "I have a nicotine addiction, that's why I cannot quit smoking". Too bad they cannot make a willpower drug.

 

[subway5c]

This could be interesting indeed.

The cure for lots of diseases 'lies within oneself'. Depression, codependent personality disorder, etc. are best cured by psychotherapy which is highly dependent on the pt's own work toward his or her own goal.

Further, genetic predispositions have been shown to exist for at least some types of alcoholics. While it is true that some of those that are genetically predisposed never develop alcholism, I believe that they are indeed more predisposed.

Alcoholism is more than just bad lifestyle choices. It is a substance dependence disorder complete with real physiological and psychological sx's.

You wouldn't attribute lack of eating in a pt with anorexia nervosa to 'poor lifestyle choices' and similarly you must treat an alcoholic's uncontrolled drinking as a symptom of a disease.

 

[JohnnyOU]

Not a disease.

Say what you want...it's not a disease.

The person craves it, wants it, and often won't stop even though they know it's bad for them...much like smoking, etc.

 

[DocBR]

The cure for lots of diseases 'lies within oneself'. Depression, codependent personality disorder, etc. are best cured by psychotherapy which is highly dependent on the pt's own work toward his or her own goal.

True, the cure may lie within oneself, but with depression, codependency, etc the path to the disease does not require someone to consciously engage in the "disease" behavior (i.e. go to the store, buy the alcohol, drink it). Yes, with depression you must make the choice to change, but you do not make the choice to bring about the disease.

Alcoholism is more than just bad lifestyle choices. It is a substance dependence disorder complete with real physiological and psychological sx's.

I am not denying the symptoms or the consequences, I am just saying that unlike other diseases, you must choose alcohol, which leads to alcoholism.

You do not choose asthma, autoimmune disorders, etc - so they are not the same (again, IMO).

 

[jdh71]

What is "disease" . . . ?

Based on the smarmy assertions so far . . . I would think the answer should be here . . .

 

[QuikClot]

here's a question for all of you.

please don't cite what the medical establishment holds as its official stance. just think for yourself.

i'm not asserting that alcoholics are inherently awful people (the abusive ones are) or they should be eradicated or anything of the sort.

but is it a disease when the cure lies within yourself? what about smoking? does a disease have to be defined by physical symptoms (ie withdrawal, delirium tremens), and if so, does that make panting after running a kind of pathology?

or is it a generalized helplessness detrimental to one's health that makes a disease a true pathology?

these are all just example questions worth mulling over; i'd love to hear all of your thoughts.

You say "don't cite . . . the medical establishment" but your question is as to what should be defined as a "disease." What is a disease, apart from what the medical establishment says is a disease? It's a functional distinction, used to guide therapies, not an objective reality. While a few diseases can be traced to a single, specific derangement of physiology, most are complex, sharing many characteristics with normal homeostasis, and the point at which they are defined as diseases is the point at which they become bothersome.

Now the question, "but is it a disease when the cure lies within yourself" has two problems with it. One is that you are assuming that the cure for alcoholism lies "within yourself." Another is that other diseases, like cancer, CAD, diabetes, etc., do not fit that description.

You may say the alcoholic can chose not to drink. Then again, you might say that the schizophrenic can chose to settle down, get a stable job and not listen to the voices. Both types of patients have brain dysfunction that will show up on a brain scan. One type rarely experiences remission; the other does more frequently.

Many diseases can be radically improved by simple choices. Don't eat junk, don't smoke, don't be idle. Yet nobody claims that diabetes, for example, is not a disease, despite the fact that it is the rare person who gets type II diabetes, for example, without making a lot of bad choices.

Again, the reason we call things diseases is so we can treat them. The idea that a disease is something you have no control over is dated and not supported by the scientific evidence. Calling something a disease does not absolve the person with the disease either of their part in their getting the disease or their responsibility to make the changes necessary for recovery. Diseases are a mixture of genes, enviroment, and choices. It's true for diabetes and it's true for substance abuse or major depressive disorder.

i'm not asserting that alcoholics are inherently awful people (the abusive ones are) or they should be eradicated or anything of the sort.

Are you joking? Make sure to check your knots before you rappel off that high horse. Not that people that think they can identify "inherently awful people" should be eradicated, or anything -- maybe just a nice camp is the desert somewhere.

 

[LJDHC05]

Running and SOB is not pathology because it is a normal physiological response...DOE is different.

Substitute Melanoma for Alcoholism- is it a disease or the result bad lifestyle choice of not wearing enough sunscreen? definitely a disease, but without the stigma of alcoholism. No one has ever started a 12-step program for tanning (perhaps I'll start one for the gals/guys that walk into class looking like oompa loompas with their orange skin).

Of course I'm also comparing apples to oranges in comparing skin cancer to a behavioral disorder/disease. It's not something that's going to come up hot on a blood/piss test, you cant give a pill and make it go away...the lines aren't as clear. Alcoholism and other addictions are even harder to call diseases when you placing your own moral views/experiences/societal influences on to a patient's situation, which is basically what your post is getting at.

My personal distinction between disease and choice is drawn at the altered brain chemistry of addiction and it's inhibition of a normal lifestyle. Much like anxiety disorder or depression, the symptoms are very real and the "cure" lies within the ability to change the altered behavior. Sounds like wishy-washy BS, but you'd be surprised what addiction can do to people

 

[Fermata]

 

[SupergreenMnM]

You say "don't cite . . . the medical establishment" but your question is as to what should be defined as a "disease." What is a disease, apart from what the medical establishment says is a disease? .

I believe up until recently (DSM II, 1970s) homosexuality was classified as a disease

 

[GoodDoctor]

QuickClot always seems to settle these types of issues pretty soundly.

To those saying it's not a disease, I think you are going with your gut feeling of what you think disease seems like.

It reminds me of friends whom I cannot convince that alcohol or cigarettes are drugs. I've had peole get quite defensive, assuming I was making a moral judgement. These are simply facts: alcohol and nicotine are drugs. But because they are not illegal and don't have the same stigma attached, most people cannot conceive of them as drugs.

You've fallen prey to similar thinking. Because we commonly think of people being victims to physical disease, many people have difficulty thinking of alcoholism as a disease because of the sense of personal responsibility involved. This is the same attitude that makes people unwilling to seek help for depression and other psychological disorders.

 

[GoodDoctor]

I believe up until recently (DSM II, 1970s) homosexuality was classified as a disease

And back then they treated people for homosexuality. Even into the 80's there were people using electroshock therapy to "cure" homosexuality.

It was removed as a disease because it was recognized that the criteria for diagnosis were based more on social attitudes rather than on sound science.

Do you think the same will happen for alcoholism? It is true that definitions and criteria for diagnosis can change as our knowledge grows. Are you suggesting that alcoloholism might be or should be removed from the DSM?

 

[DocBR]

To those saying it's not a disease, I think you are going with your gut feeling of what you think disease seems like.


You've fallen prey to similar thinking. Because we commonly think of people being victims to physical disease, many people have difficulty thinking of alcoholism as a disease because of the sense of personal responsibility involved. This is the same attitude that makes people unwilling to seek help for depression and other psychological disorders.

This is true, however the OP is asking for personal views on alcoholism, not the medical community definition of a disease. IMO, a disease is something that effects you, where as alcoholism is something you effect upon yourself.



Obviously, according to my definition of disease there are gray areas, such as the melanoma example someone else mentioned above, however I still think my definition holds up because melanoma is something that can HAPPEN to you even without poor lifestyle choices, normal people do get melanoma without being heavy tanners. Xeroderma pigmentosum can result in melanoma with very little sun exposure. I know that is about as extreme of an example as there can be, but the point is, it does happen.



You will never find an alcoholic who is symptomatic unless they drink alcohol.

 

[OCPreMed]

Like most drugs, alcohol alters brain and body chemistry and thus functions.. diseases also alter function and cause symptoms... a chronic alcoholic will have up regulated NMDA receptors, down regulated GABA receptors, decreased REM sleep, induction of P-450 liver enzymes that leads to increased metabolism of sex and various other hormones, GI problems due to increased HCL and pepsin, down regulated endogenous opioids and a host of withdrawal symptoms including tremors, high blood pressure, erratic heart beats, delirium tremens (hallucinations, nightmares, fevers, agitation), nausea, anxiety and seizures... all of this without taking into obvious consideration damage to liver cells, increased risk of various cancers, heart attacks, atherosclerosis, and malnutrition...

My point, substance dependency with alcohol can be viewed as a "disease" with symptoms, but one must take into consideration that one does not "catch" alcoholism by getting sneezed on, one cannot inherit full blown alcoholism from their parents and it takes months to develop the bad drinking habits.. Unlike most diseases, alcoholism does involve a degree of responsibility directly to the patient because initially it was their choice to drink, but as social drinking turns into abuse that then transforms into dependency, it really is not their choice, they are too far gone, their brain has changed.

While it is not a traditional disease such as malaria, IMHO treating alcoholic patients must be viewed upon as a disease because of what the alcohol has done to their mind and body, and by that point, they are no longer in control.

 

[Tired]

You say "don't cite . . . the medical establishment" but your question is as to what should be defined as a "disease." What is a disease, apart from what the medical establishment says is a disease? It's a functional distinction, used to guide therapies, not an objective reality. While a few diseases can be traced to a single, specific derangement of physiology, most are complex, sharing many characteristics with normal homeostasis, and the point at which they are defined as diseases is the point at which they become bothersome.

So is it a disease or not? Your words are pretty, but f-ing man up and make a choice.

Now the question, "but is it a disease when the cure lies within yourself" has two problems with it. One is that you are assuming that the cure for alcoholism lies "within yourself." Another is that other diseases, like cancer, CAD, diabetes, etc., do not fit that description.

Shut up. You know damn well that the answer to cancer or heart disease does not "lie within yourself". Quit your semantic stupidness.

You may say the alcoholic can chose not to drink. Then again, you might say that the schizophrenic can chose to settle down, get a stable job and not listen to the voices. Both types of patients have brain dysfunction that will show up on a brain scan. One type rarely experiences remission; the other does more frequently.

Again, shut up. The alcoholic can not put alcohol into their body, and their symptoms will dissipate. The schizoprenic can be locked in a room, but their symptoms will still arise. You know this. So shut up.

Again, the reason we call things diseases is so we can treat them. The idea that a disease is something you have no control over is dated and not supported by the scientific evidence. Calling something a disease does not absolve the person with the disease either of their part in their getting the disease or their responsibility to make the changes necessary for recovery. Diseases are a mixture of genes, enviroment, and choices. It's true for diabetes and it's true for substance abuse or major depressive disorder.

You like fancy words so that people will think you are smart. But really, all you have is a bunch of really stupid comments that demonstrate nothing. Get a life.

Are you joking? Make sure to check your knots before you rappel off that high horse. Not that people that think they can identify "inherently awful people" should be eradicated, or anything -- maybe just a nice camp is the desert somewhere.

And again, shut up. Your post is very long, and contributed nothing to anything. This is on theme with most of your posts, where you use fancy rhetorical tools to essentially say nothing. Look, when threads ask for your opinion, either give one, or STFU, because we're all really tired of your long-winded comments that say nothing at all.

 

[G.O.A.T.]

As a side note, have you seen the new commercials where they are advertising a stop smoking drug? "I have a nicotine addiction, that's why I cannot quit smoking". Too bad they cannot make a willpower drug.

several professors at my school, including pharm and path profs, have stated during lecture that quitting smoking is more difficult that quitting heroin.

 

[Fermata]

several professors at my school, including pharm and path profs, have stated during lecture that quitting smoking is more difficult that quitting heroin.

I'm sure price and availability probably factor in beyond how addictive stuff like nicotine is.

 

[G.O.A.T.]

I'm sure price and availability probably factor in beyond how addictive stuff like nicotine is.

they were addressing physiological responses, such as nicotine affecting the symp, parasymp, msk systems while heroin only effects opiate receptors. we are talking about heroin addicts here, people doing heroin everyday, so price and availability is not much of an issue, since they obviously have a steady source and means to obtain it.

 

[Fermata]

they were addressing physiological responses, such as nicotine affecting the symp, parasymp, msk systems while heroin only effects opiate receptors. we are talking about heroin addicts here, people doing heroin everyday, so price and availability is not much of an issue, since they obviously have a steady source and means to obtain it.

I don't doubt it. My father told me that the first thing he does every morning after waking up is reach over onto the nitestand for a cigarette.

He hasn't smoked in over 20 years.

 

[Stolenspatulas]

SEMANTICS.

what is ''disease''?

 

[jdh71]

The alcoholic can not put alcohol into their body, and their symptoms will dissipate. The schizoprenic can be locked in a room, but their symptoms will still arise.

A common misunderstanding of alcoholism. When the alcoholic quits drinking he is not drunk, but the symptoms have not "dissipated" for drinking is merely a single symptom of the disease, not the disease itself. The alcoholic's problem is not the drink . . . it's his thinking

 

[jdh71]

Disease is actually a pretty simple concept in my opinion. It's all comes back to the physiology, or rather the alteration of normal physiology. Alcohol causes a change in brain physiology, including reinforcing dopamine pathways to the nucleus accumbens - similar pathways that reward you for finding food or sex or video games. Chronic alcohol use can cause changes in many different receptor numbers as referenced above. What is this, but an aberation of the normal brain physiology and therefore a disease? The brain being the most interesting organ in the body has the unique ability to moderate organic disease processes with thinking/cognition. A good analogy would be depression - definitely a disease based on an altered brain physiology and symptomatic description by behavior only - cognitive behavioral thepray has shown itself to be just as effective if not more so than SSRI (heck, I remember reading one study showing moderate exercise to be just as effective as SSRI in mild to moderate depression). The problem for the alcoholic is NOT the drink - the drink is merely the most obvious behavior symptom - the probelm for the alcoholic is his thinking and approach to life. The alcoholic's first step is to stop the drink - which, and pay attention closely(!), is a choice. The problem is that if the alcoholic does not treat his real disease he will drink again - will make that choice again. Once drunk, the alcoholic will lose real choice in the drink and will find himself drunk - maybe for days. What is important when looking at this disease is where the disease really is and where the treatment lies. Having a problem with alcohol does not and never will excuse any bad behavior. The alcoholic is responsible to take care of his disease - him an no one else. There are no excuses.

 

[bioteach]

I've wondered the same thing. I would be interested in understanding the genetic components a bit better. My step-father is an identical twin. They were raised together and were very close as young men. His twin brother died at age 55 as a result of alcoholism. He had a Phd in botany but by the end was essentially homeless and couldn't get a job watering plants at home depot. He lost all connection to his family and was never married. It was very sad. Alcohol destroyed his life. Or he destroyed his life with alcohol, however you want to look at it.

My step-father, despite having the same set of DNA, has no problems whatsover with addictions, alcohol or otherwise. He quit smoking cold-turkey after 20 years and never wanted another cigarette. He drinks socially, but that is it. He is extremely successful in both family and work.

So, I know twins can get different diseases, environmental factors, etc. But...I do find the disparity here striking.

Was it just a weakness on my uncle's part, or some sort of switching on/off of the genes that caused the differences in their fate?

 

[LJDHC05]

I've wondered the same thing. I would be interested in understanding the genetic components a bit better. My step-father is an identical twin. They were raised together and were very close as young men. His twin brother died at age 55 as a result of alcoholism. He had a Phd in botany but by the end was essentially homeless and couldn't get a job watering plants at home depot. He lost all connection to his family and was never married. It was very sad. Alcohol destroyed his life. Or he destroyed his life with alcohol, however you want to look at it.

My step-father, despite having the same set of DNA, has no problems whatsover with addictions, alcohol or otherwise. He quit smoking cold-turkey after 20 years and never wanted another cigarette. He drinks socially, but that is it. He is extremely successful in both family and work.

So, I know twins can get different diseases, environmental factors, etc. But...I do find the disparity here striking.

Was it just a weakness on my uncle's part, or some sort of switching on/off of the genes that caused the differences in their fate?

Schizophrenia only has a 50% penetration rate in homozygotic twins...when n=1 you've got conjecture. It's probably a two hit model of genetics and environment.

Anyway, the reason I used melanoma and sunscreen as an example was because it is a choice leading to a disease. Sure xeroderma pigmentosa is a possibility, but the far more common cause is the conscious choice/sheer laziness of over exposure to sun. How about MI's and cheeseburgers, does that work for you? Or maybe PTSD and military volunteers? Look at the early thinking of the AIDS epidemic and the social stigma associated with homosexuality...completely off base. I still think that the social stigma and personal experiences are part of what make it so difficult to define as a "disease" for so many people.

It's also a mental disease...like I said earlier: You detect it in a piss test, there's no "alcoholic" gene, there's no abnormal growth on the patient's forehead that jumps out at you and screams "I'M AN ALCOHOLIC". Psychiatry is still fairly rudimentary in how it deals with its patients and DSM IV is just the current standard of care, not the be-all and end-all of what disease is. As was said, it's the faulty thought process that is pathologic, not the drinking.

 

[njbmd]

Moving to Topics in Healthcare as alcoholism is not specific to Allopathic medical school.

 

[GuzzyRon]

Just like you all cannot agree with each other, 'experts' (medical doctors included) also do not agree on whether alcohol is a disease or not. The issue is very debatable.

Those who favor the disease model of alcoholism consider it a disease because dependence is often characterized by a loss of control over drinking. Besides, alcoholism may be a symptom to some other underlying conditions such as depression, or some type of personality defect. In addition, alcohol dependence often exists within a dysfunctional family, thereby suggesting it could be some type of disorder that runs in certain families.

However, on the flip side, those who are opposed to calling alcoholism a disease often say that calling it a disease severely weakens the traditional concept of diseases. If alcoholism is a disease, then what causes it? And also, how are alcohol abusers different from other people except that they engage in excessive alcohol consumption and have many alcohol related problems?

 

[fobw]

Alcoholic premed here. 10 years sober. Paternal grandmother died of addiction to narcotics. Maternal aunt (a nurse) died of a drug and alcohol overdose. Other relatives "living" as addicts. I have a champion pedigree.

Y'all are doctors-in-training, correct? So I don't have to make a Lifetime Channel movie out of this, with the happy endings and epiphanies, right?

What difference does it make if you're able to legitimately call alcoholism a disease or not? Does it give you cause to treat your patients differently? Is the real question, in the disease question, "why do people do stuff to f*** themselves up?" If so, the answer is way too complicated to understand, ever. People always have, and always will, f*** themselves up. People who have f***ed themselves up will forever come to you for treatment of the things they've f***ed up. You can tell them, as a doctor, to stop f***ing themselves up, and now and then, an individual will listen, and give it a shot, and maybe once in your lifetime, they'll actively stop f***ing themselves up. 99.9% of the time they won't. If you come off as contemptuous and/or judgemental, I guarantee no addict will give your opinion a second thought. We're very good at pretending to care until we don't have to pretend to care. Pediatrics is perhaps the best specialty if you can't handle adults who have f***ed themselves up. And you still have to deal with parents. This aspect of practicing medicine is very simply going to suck.

Is it a disease? I don't know. I know that if I have one drink, then I'm not human any more, but a rodent looking to build, protect and consume my stash. Keeping myself from taking that first drink is the job of being a "recovering" alcoholic. It took a series of unlikely events (call them miracles if you're Oprah) to get me to stop. It takes AA and a lot of very painful honesty, at least once a week, to keep me clean. I'd give myself about 6 months if I stop doing AA, and I'd likely be dead within a year. I'm extremely lucky that AA doesn't strike me as insipid; this makes me an outlier data point.

As a physician, my strategy with addicted populations will be to deal out consequences, without judgement, and offer choices. "Your liver panel says you'll be dead in about a month. Ready for rehab yet? Want to talk to somebody who stopped?" It'd be really easy for me as an alleged healer to take it personally that somebody doesn't want to heal. But it's not about me, and unless that addict in front of me is having a (choir boys) moment of clarity (end choir boys) it's not my turn to be influential.

You can do all the DSM defs and etiology studies and legislature you want. Addicts will always find a way get high, and a very small number of them will recover. Just hope it's not you or your loved ones.

 

[DocBR]

several professors at my school, including pharm and path profs, have stated during lecture that quitting smoking is more difficult that quitting heroin.

I have heard the same thing from professors, but hundreds of thousands of people have quit smoking - difficult or not, it is doable without drugs.

If I were a smoker, I would probably opt for zyban or chantix as well - easier is, well easier, but I wouldn't delude myself into believing that it was the only way.

 

[QuikClot]

And again, shut up. Your post is very long, and contributed nothing to anything. This is on theme with most of your posts, where you use fancy rhetorical tools to essentially say nothing. Look, when threads ask for your opinion, either give one, or STFU, because we're all really tired of your long-winded comments that say nothing at all.

I'm very sorry you find the ability to string two sentences together threatening. If it's something you wish you were good at, you'll find that like any other skill, you can improve with practice. Meanwhile, whiny temper tantrums are not going to win you the respect you so obviously crave.

 

[QuikClot]

I believe up until recently (DSM II, 1970s) homosexuality was classified as a disease

That's a good point. The medical establishment can certainly classify things as diseases based on biased, subjective grounds. Nobody, though, argues that alcoholism is a harmless condition vilified by society (with the exception of addicts with active disease -- they often do.)

 

[Critical Mass]

It doesn't matter what you call it. If someone needs medical treatment, then it's my view that the medical establishment should treat the condition. If you have to call it a disease to get insurance to reimburse it or whatever, then fine.

Honestly, how often does a patient come in with a problem that they didn't help to create?

Is obesity a disease? Hypertension? Addiction in general?

Does it matter?

If stating that alcoholism is a disease brings more people in for treatment, I'm fine with it.

 

[naegleria brain]

quikclot...
your post left me speechless; youre an idiot. im simply presenting a situation and you tell me to get off my high horse. absolutely spectacular people skills you got going for you, simply amazing.

for the rest of you, i think that it's not a disease. our school requires us to sit in on an AA meeting in the back and observe the dynamics, and this is what engendered the discussion.

making it a disease allows them to admit they are powerless against it. the power to help them, therefore, is through God. i believe this is a scapegoat to lift blame off themselves to "relieve the pressures" of trying to quit and getting your motivation through friends, community, and, of course, the higher power.

but alcoholism isnt just abusing alcohol. the vast majority of those people were seriously very different. they had addictive personalities. they cant even take prescription drugs (bactrim even for a UTI) without abusing it. they were gamblers, heroin addicts, etc. every little thing they undertook, from poker, to blackjack, to heroin to orgies and swingers, they abused it and got out of control. so maybe there is something genetic.

but calling it a disease and claiming they are powerless on their own strips them of their own resolve to find it in themselves, and forces an outside source. this is not true as it IS entirely possible to cure yourself, as, of course, the cure lies within. they may look to god for strength, but its ultimately on them not to reach for the rum, no matter their reasoning.

i asked you all not to look to the current medical establishment because in the next twenty years we will define it. its stupid to go off what our predecessors thought (ie homosexuality is a disease) when such things are constantly evolving.

however, what about delirium tremens. now the "cure" has some pretty grave side effects. of course this can be brought about by tapering themselves off, but now the pathology has a unique aspect.

i dont think alcoholism is a disease because it's a choice. a true disease isnt a choice, its a pathology that has happened to you. but what about HIV? that was a poor choice on one's part, unless congenital. yet, it's not irreversible, the cure is not within yourself. alcoholism, on the other hand, is reversible.

has anyone else observed AA meetings? i highly recommend you guys go to one, its very interesting, and, in my case, made me believe that it is NOT a disease.

when i even broached the subject that the cure lies within themselves, they seemed offended, saying it is a disease that only faith in God can cure. i'm not sure if this is the healthiest attitude. but it works for some people, so now what?

 

[McDoctor]

Alcohol dependence is a disorder. Pretty much all conditions listed in the DSM-IV are classified as disorders. By definition, they all share identifiable characteristics which lead to some degree of societal and medical dysfunction. There may be observable physiologic differences, perhaps by functional MRI or advanced imaging studies, but for the most part all such disorders, like alcohol dependence, are diagnosed clinically and routine diagnostics studies are of no value. There is pretty good inter-rater reliability for all diagnoses listed in DSM-IV. The bottom line, if its in the DSM-IV, then there exists copious scientific evidence to support its existence.

There is no point in debating this, unless you are one of these mental illness denying idealogues like Scientologists. In which case, there is still no point in debating this. There is a vast medical consensus that supports the diagnosis of "alcohol dependence disorder" as a clinical entity. There are some interventions which have demonstrated benefit in randomized controlled trials. Your job as a physician is to learn how to identify these disorders, like alcohol dependence disorder or major depressive disorder, and intervene with appropriate treatment when necessary.

There is a scientific consensus that supports the inclusion of alcohol related disorders in the DSM-IV. To say this is a controversial notion is false. The controversy surrounds appropriate treatment. Some medications may be helpful. Some therapeutic strategies may be helpful. However, IMO, there is no valid scientific evidence to support AA as a primary treatment modality. This is the point where the debate tends to become emotional for people.

Also, terms like "disease model", addiction, alcoholism, clean, sober, dry...these are not really medical terms, they mostly come from 12 step materials like literature from AA or NA. This is where confusion comes in as well. We should try to avoid these terms when we are wearing are doctor hats, they are nebulous terms, and mean different things to different people.

Sorry to get on a soapbox, I just get frustrated with what I see as "psychiatry denial", a'la Tom Cruise, among medical professionals and pre-professionals and I think rejecting alcohol dependence as a medical disorder is no different. I have done some advanced training through the American Academy of Addiction Psychiatry for pharmacologic management of substance abuse disorders, so I think I'm qualified to preach just a little.

Besides, I'm just parroting the scientific consensus. If I had an opinion that went against the consensus, I would bolster it with more than just "Its not a disease because the cure lies within yourself".

 

[naegleria brain]

You say "don't cite . . . the medical establishment" but your question is as to what should be defined as a "disease." What is a disease, apart from what the medical establishment says is a disease? It's a functional distinction, used to guide therapies, not an objective reality. While a few diseases can be traced to a single, specific derangement of physiology, most are complex, sharing many characteristics with normal homeostasis, and the point at which they are defined as diseases is the point at which they become bothersome.

the medical establishment has been involved with tuskegee, experimenting with jews in the holocaust, and calling homosexuality a disease. we are not revolutionizing treatment, we are simply discussing definitions and semantics. therefore we should not be limited to the current establishment's definitions, especially when in twenty years we will be defining them.

Now the question, "but is it a disease when the cure lies within yourself" has two problems with it. One is that you are assuming that the cure for alcoholism lies "within yourself." Another is that other diseases, like cancer, CAD, diabetes, etc., do not fit that description.

you reiterated exactly what i just said. yes, i am saying that the cure lies within themselves. ie stop drinking. cancer treatment doesnt lie within themselves, they need methotrexate, surgical resection, radiation, etc. what's your point?

You may say the alcoholic can chose not to drink. Then again, you might say that the schizophrenic can chose to settle down, get a stable job and not listen to the voices. Both types of patients have brain dysfunction that will show up on a brain scan. One type rarely experiences remission; the other does more frequently.

the schizophrenic still hears voices even if he chooses to ignore them. the alcoholic wont be jaundiced if he stays away from the booze

Many diseases can be radically improved by simple choices. Don't eat junk, don't smoke, don't be idle. Yet nobody claims that diabetes, for example, is not a disease, despite the fact that it is the rare person who gets type II diabetes, for example, without making a lot of bad choices.

agreed. but the salient difference is type ii diabetes is a permanent pathology. the "cure" isnt in themselves. improving diet, etc. wont make them normal again, they need lifetime metformin, and eventually insulin, etc. same thing with the risky sexual deviant who contracts HIV. it was purely poor choices, but revising his behavior wont ever cure it. alcoholism, however, can, and not through drugs, but solely through your behavior.

Again, the reason we call things diseases is so we can treat them. The idea that a disease is something you have no control over is dated and not supported by the scientific evidence. Calling something a disease does not absolve the person with the disease either of their part in their getting the disease or their responsibility to make the changes necessary for recovery. Diseases are a mixture of genes, enviroment, and choices. It's true for diabetes and it's true for substance abuse or major depressive disorder.

i agree with this. but have you been to an AA meeting? by calling it a disease they really do claim they have no power over it, and must look to a higher power.
we dont treat alcoholism. we give them benzos to control their desire for more alcohol. we give acetaldehyde dehydrogenase inhibitors so they feel like crap when they drink. but we dont cure it. this however holds true for other actual diseases as well.

Are you joking? Make sure to check your knots before you rappel off that high horse. Not that people that think they can identify "inherently awful people" should be eradicated, or anything -- maybe just a nice camp is the desert somewhere.

this was a qualifier so the irritable on SDN dont get their panties in a bunch. i'm sorry that my attempts to pacify these people induced your panties into a bunch.

and for the record, i dont need knots because i never fall from my horse

i apologize for the previous post bitching you out quikclot; your last statement was just unnecessarily idiotic, though your post did have some good points.

 

[naegleria brain]

Alcohol dependence is a disorder. Pretty much all conditions listed in the DSM-IV are classified as disorders. By definition, they all share identifiable characteristics which lead to some degree of societal and medical dysfunction. There may be observable physiologic differences, perhaps by functional MRI or advanced imaging studies, but for the most part all such disorders, like alcohol dependence, are diagnosed clinically and routine diagnostics studies are of no value. There is pretty good inter-rater reliability for all diagnoses listed in DSM-IV. The bottom line, if its in the DSM-IV, then there exists copious scientific evidence to support its existence.

There is no point in debating this, unless you are one of these mental illness denying idealogues like Scientologists. In which case, there is still no point in debating this. There is a vast medical consensus that supports the diagnosis of "alcohol dependence disorder" as a clinical entity. There are some interventions which have demonstrated benefit in randomized controlled trials. Your job as a physician is to learn how to identify these disorders, like alcohol dependence disorder or major depressive disorder, and intervene with appropriate treatment when necessary.

There is a scientific consensus that supports the inclusion of alcohol related disorders in the DSM-IV. To say this is a controversial notion is false. The controversy surrounds appropriate treatment. Some medications may be helpful. Some therapeutic strategies may be helpful. However, IMO, there is no valid scientific evidence to support AA as a primary treatment modality. This is the point where the debate tends to become emotional for people.

Also, terms like "disease model", addiction, alcoholism, clean, sober, dry...these are not really medical terms, they mostly come from 12 step materials like literature from AA or NA. This is where confusion comes in as well. We should try to avoid these terms when we are wearing are doctor hats, they are nebulous terms, and mean different things to different people.

Sorry to get on a soapbox, I just get frustrated with what I see as "psychiatry denial", a'la Tom Cruise, among medical professionals and pre-professionals and I think rejecting alcohol dependence as a medical disorder is no different. I have done some advanced training through the American Academy of Addiction Psychiatry for pharmacologic management of substance abuse disorders, so I think I'm qualified to preach just a little.

Besides, I'm just parroting the scientific consensus. If I had an opinion that went against the consensus, I would bolster it with more than just "Its not a disease because the cure lies within yourself".

mcdoctor, no one here has an anti-psychiatry ideal. and if one of us do, thats not the object of the discussion. this is limited to alcoholism. tom cruise is a *****.

you cite a lot of DSM IV, but that's what i asked people NOT to do. its like going to the dictionary and saying its true. like it's been said before, the DSM IV listed homosexuality as a disease, and at that time, i'm sure they thought there were good reasons for it. there are arguments that go both ways, so just because it's in there doesnt mean it should be there.

yes there are studies showing that their are changes in the brain and whatnot from alcoholism. but so are there in watching tv, going on the internet, talking on the phone, etc. the only difference is alcoholism is clearly detrimental to your health. the therapies aimed at alcoholism are directed at supporting the person's desire to stop drinking

AA isnt yet an approved modality, but the acetaldehyde inhibitors - they make you feel like crap after drinking. this makes them WANT TO STOP. the benzos give them a false sense of satisfaction and that they dont need alcohol. this makes them WANT TO STOP. these aren't long term therapies, these are aimed at helping them stop. thus, the ultimate cure lies within THEM SAYING enough is enough.

the cure lies within itself was just a line to get people thinking. and we both know it holds a lot of merit. an argument isnt based on its plethora of words but the meaning it holds.

 

[changeofheart77]

Things are not always as simple. If we say alcoholism is a disease then ultimately we would view liver transplantation for alcoholic ESLD not any diff from etiologies like HepC, NASH, autoimmune, etc. But we don't. We are not impartial to the character weakness that brought about the disease. While the liver goes to the medically appropriate candidate, which patient do you think gets the most of our compassion?

Have you heard of the trauma surgeon who has to take care of the badly injured victim and the drunk driver? Isn't it ironic that the victim usually dies and the culprit gets by with a bruise and a scratch?

Sure, let's call alcoholism a disease. We might as well as try to treat alcoholics before they cause more harm to themselves and others. But to ask that we be impartial to this disease is a stretch.

 

[McDoctor]

mcdoctor, no one here has an anti-psychiatry ideal. and if one of us do, thats not the object of the discussion. this is limited to alcoholism. tom cruise is a *****.

you cite a lot of DSM IV, but that's what i asked people NOT to do. its like going to the dictionary and saying its true. like it's been said before, the DSM IV listed homosexuality as a disease, and at that time, i'm sure they thought there were good reasons for it. there are arguments that go both ways, so just because it's in there doesnt mean it should be there.

yes there are studies showing that their are changes in the brain and whatnot from alcoholism. but so are there in watching tv, going on the internet, talking on the phone, etc. the only difference is alcoholism is clearly detrimental to your health. the therapies aimed at alcoholism are directed at supporting the person's desire to stop drinking

AA isnt yet an approved modality, but the acetaldehyde inhibitors - they make you feel like crap after drinking. this makes them WANT TO STOP. the benzos give them a false sense of satisfaction and that they dont need alcohol. this makes them WANT TO STOP. these aren't long term therapies, these are aimed at helping them stop. thus, the ultimate cure lies within THEM SAYING enough is enough.

the cure lies within itself was just a line to get people thinking. and we both know it holds a lot of merit. an argument isnt based on its plethora of words but the meaning it holds.

AA meetings are not scientific, not medical, and should not be part of medical education. If I had to base my conclusions on AA meetings, then I would be skeptical of alcohol dependency as a "disease" as well. I think this is why you are skeptical. I can respect that. I felt similarly after being exposed to AA and 12 step groups. You need to step back from that experience and look at the whole thing objectively.

Objectively, the criteria formulated to diagnsoe alcohol dependence has good inter-rater reliability. Use of the criteria in the DSM-IV identifies > 95% of individuals with problematic alcohol use. This is regardless of race or sex or age or cultural background. We use criteria like these to identify medical conditions all the time. The diagnosis of migraine is similarly also based solely on objective, observable, self reported criteria, with a similar degree of inter-rater reliability.

If we can recognize clusters of behavior which cause significant health and societal dysfunction, then it is useful to classify them, name them, and then look for potential treatments and/or study any possible underlying causes. Substance abuse disorders fall into this category. Just because one treatment strategy for alcohol dependence is a bogus 12 step program, that shouldn't mean we reject the existence of underlying disorder. That would be like rejecting the existence of cancer because some people use psychic healing as a treatment strategy.

I want to stress that alcohol dependence is a disorder, not a disease. The distinction is important, because what is considered a disorder changes with shifts in culture and social norms. For instance, dyslexia can only be considered a disorder in literate cultures. Homosexuality was perhaps considered a disorder at a time when partaking in homosexual activities had significant societal repercussions. If we lived in a society that routinely tolerated the reckless actions of drunk people, perhaps it would be eliminated from the DSM-IV as well.

Finally, I have to give alot of credibility to the medical establishment because I am part of it, as are you. I think that if you are going to have an opinion that goes against the medical establishment, you really need to arm yourself with alot of facts and have good reason to defend your position. Alot of smart people are going to disagree with you. The authors of the DSM-IV didn't put it together on a whim. They looked at a ton of data.

I just think your school failed you to some extent by introducing you to the topic via an unscientific, 12 step group. There is some value to knowing what an AA meeting is like, mostly for the purpose of ascertaining that there is nothing medical or scientific about it. It is essentially a form of religion. Don't mistake the views of AA as the mainstream medical establishment.

 

[lakewood]

has anyone else observed AA meetings? i highly recommend you guys go to one, its very interesting, and, in my case, made me believe that it is NOT a disease.

I think the previous poster who told you to get off your high horse was being accurate... perhaps it is you without the social awareness here. The way you are coming across is not half as impartial or informed as you must think.

You went to ONE meeting and formed all of these opinions that you offer? That would be laughable to anyone who has ever had anything to do with a 12 step program. Go to 90 meetings in 90 days and read the big book if you actually want to experience what these programs have to offer (which is the standard recommendation for a beginner). The notion that one meeting will make a meaningful (or accurate) influence is a joke.

There are so many kinds of meetings. You obviously were at an open meeting. You have not experienced a closed meeting. Was it a discussion meeting, a big book meeting, a speaker meeting? Have you experienced any of that before declaring your final opinion? The quality of meetings vary night to night, and especially location to location. There are great weekly meetings and unimpressive meetings that are very boring. Your problem with the use of "god" is symptomatic of your inexperience. Countless alcoholics and addicts in AA, NA, or other 12 step programs are atheists and agnostics. Your understanding of the use of the phrase "higher power" is immature and incomplete, despite what any single member may have said at a single meeting.


You have not even scratched the surface of AA if you have attended a single meeting, and if this is the basis for your opinion, I recommend further study. You may maintain your original opinion, which is fine, but I think you are projecting an air of arrogance in your supposed knowledge on the subject with such little experience. There are other similar flaws in your posts that I could point out, but I don't feel motivated to do so. If you really want to learn more, you will. If you would rather decide that your present knowledge is adequate, well, you probably already have.

the cure lies within themselves

What objective evidence do you have to support that statement?



What objective evidence do you have to support that this condition can even be cured?





And to everyone else comparing addiction to depression, since when is depression a "disease" ? Is it not a "disorder" ? Am I mistaken? I would compare addiction more to OCD than any other mental health disorder, but that is merely my opinion. Nonetheless, the debate over naming addiction as a disease is purely semantic.





After reading the opinions of so many of you MDs, I am relieved to know that treatment for addiction is more often in the hands of psychologists, counselors, and social workers. I sense very little empathy or compassion, and an overall detachment from the people in life who you just don't seem to understand. I pity those of you whose own interpersonal detachment yields hostility and resentment toward anyone suffering from a mental health disorder, no matter how you choose to label it.

Stay humble.

 

[naegleria brain]

mcdoctor: thanks for your contributions; i understand, and agree, with a lot of your points. i do feel that the medical establishment is an ever-changing one, and one shouldnt be afraid to question it however. data is constantly changing as is standard of care, etc.

lakewood: if you get to medical school, or residency, or a profession of any kind, you'll soon realize its impossible to go to 90 meetings for 90 days and read the whole big book. we make judgements on what we see and what we know; its human nature, its universal, and its the best we can do with limited exposure.

on psych rotations, no doctor, student, resident has spent countless hours in free clinics holding the hands of their depressed patients and living their lives day in and day out, and by your logic, only those with 20 years of experience are qualified to treat patients, which clearly has flaws in it.

if you think i'm conceited, you probably share that perception with many others of the medical profession, and there's nothing i can do to change that. in fact, your resultant ramblings indicate that this is indeed your viewpoint

however i do submit that this is partially due to your own ill-conceived notions of the entire field. psychiatrists are in fact medical doctors, as opposed to psychologists who are not. and psychiatrists treat more patients yearly, and thus are more involved with patient care, than psychologists.
http://psychservices.psychiatryonline.org/cgi/content/full/53/8/977

perhaps you should reexamine your generalizations more carefully before making such statements

stay knowledgeable

 

[lakewood]

I really hate taking part in online forum debates, I get nothing out of it and usually only feel frustrated. But one more post....

I need to dispel the notion that AA is even the sole representative of the disease model of addiction. I keep reading "Have you been to an AA meeting?" There are numerous treatment methods which do not rely on a 12 step program yet do rely on a diagnosis (for insurance, etc). AA is a very specific treatment program which is free of cost, requires no diagnosis, and is open to anyone who wishes to stop drinking. AA does not represent all of alcoholism treatment. Plain and simple.

But, if using a "higher power" to combine both an internal and an external locus of control is somehow problematic to you, perhaps it is time to reconsider what medication is in the first place. Is it not the same? If not, there would be no placebo effects on more traditional "diseases."

I should hope that some of the posters here never treat patients with compulsive behaviors, ie. OCD, eating disorders, or addiction. Beyond the simple semantics, the ignorance (arrogance?) is frightening.


Would it make you happier if it was called a "behavioral disorder" ? In the end, it is irrelevant, and the time spent debating the differences between two similar terms could have been better spent learning more about the condition itself, or better yet, the people who suffer from it.

 

[lakewood]

Ha! If seeing more patients (and that alone) makes you more involved with patient care, I contend that the registration clerk is most involved with patient care, considering he/she registers every single patient.

Your response is such a psychiatrist stereotype I almost want to ask if it was a joke.

If you believe that the number of patients seen represents the level of your involvement, or quality of care, you are deluding yourself.



Also, if you want to make more time for human interaction (not that I expect you to attend 90 meetings), you could easily spend an hour doing so rather than being on an Internet forum. I think you might learn more about human compassion at another AA meeting than you will learn debating on the web. Obviously, based on the few posts by you that I have read, I feel that would be helpful to you, especially considering the immense volume of patients you will be seeing. Ha!

 

[DocBR]

It doesn't matter what you call it. If someone needs medical treatment, then it's my view that the medical establishment should treat the condition. If you have to call it a disease to get insurance to reimburse it or whatever, then fine.

Honestly, how often does a patient come in with a problem that they didn't help to create?

Is obesity a disease? Hypertension? Addiction in general?

Does it matter?

If stating that alcoholism is a disease brings more people in for treatment, I'm fine with it.

I agree 100%.

Despite my hardline stance that it is not a disease, I agree completely that the need to treat it is as real as any disease.

As far as patient care, the need to treat it trumps all the debate over how to define it. When it comes down to it, we do not need to define it, we simply need to treat it as best we can.

Luckily, here on SDN we can debate to our heart's content, because after all we are merely debating for amusement.

 

[DocBR]

I should hope that some of the posters here never treat patients with compulsive behaviors, ie. OCD, eating disorders, or addiction. Beyond the simple semantics, the ignorance (arrogance?) is frightening.

You must be new to SDN....

You make the assumption (falsely) that what is said here, would be said to patients. First off, we are talking about a nameless, faceless alcoholic who has no personal history.

Obviously, if we were treating alcoholic patients, taking into account their psychological state, family history, socioeconomic pressures, etc it would be a very different story.

Furthermore, just because someone disagrees with your view on how to define alcoholism, it does not imply that they would treat patients without compassion, caring and understanding - while staying nonjudgmental.

If you cannot look beyond your own emotionally charged, visceral response to the topic and see that this is nothing more than a conceptual debate - then how will you survive what is to come in medical school?

No one is debating the need for compassion, understanding and assistance to alcoholics. Nor is anyone saying that we should make judgements about the choices they have made in their lives.

 

[naegleria brain]

Ha! If seeing more patients (and that alone) makes you more involved with patient care, I contend that the registration clerk is most involved with patient care, considering he/she registers every single patient.

Your response is such a psychiatrist stereotype I almost want to ask if it was a joke.

If you believe that the number of patients seen represents the level of your involvement, or quality of care, you are deluding yourself.



Also, if you want to make more time for human interaction (not that I expect you to attend 90 meetings), you could easily spend an hour doing so rather than being on an Internet forum. I think you might learn more about human compassion at another AA meeting than you will learn debating on the web. Obviously, based on the few posts by you that I have read, I feel that would be helpful to you, especially considering the immense volume of patients you will be seeing. Ha!

debating it engenders new thoughts and theories. studying informs you of the current theories.

debating for a year leads to 100 different ideas. studying for a year leads to nothing, except knowing what other people said; there's a limit to studying, but not to debating.
(damn commie!)

patient interaction was the assertion stemming from YOUR belief as to the importance of going to 90 meetings. if you don't think there's a link, then your 90 visit assertion came out of your ass

i, however, speak with my mind. it just seems to come from my ass since i'm so high on my horse and you're situated posteriorly

 

[dpmd]

I think some of you are confused as to what alcoholism is. A person can be an alcoholic, yet not drink any alcohol. There is no cure. There are various methods of helping the alcoholic not have problem drinking behaviors, but that person is always going to be an alcoholic. You want to call it a disease, a disorder, a character flaw, or whatever. The bottom line is that willpower will only ever be able to keep the alcoholic from taking a drink that moment. They cannot will themselves to not WANT a drink. It's interesting how people are so quick to judge what they see as a lack of willpower. I wonder if those same people have such excellent willpower that they excercise every day, eat healthy foods at all times, floss three times a day, never smoke, drink to excess, or engage in any of the mulitude of behaviors that can lead to disease or dysfunction of the body. I, on the other hand, recognize the difficulty involved in changing personal behavior even when the need to change is recognized. Add in the fact that there is potentially something different about the alcoholics brain which makes it even more difficult to recognize the need for change, and to actually make the change. I can say that I don't understand the person that drinks so much they have destroyed their live, can't hold a job, and now lives on the street. However, I am sure that someone could be equally befuddled with why I complain about my weight gain but don't restrict my calorie intake or increase my exercise. If calling something a disease leads to treatment, I am ok with it. However, I don't think that it should be an excuse for bad behavior. If you get drunk and kill somebody I would want punishment on top of treatment (just as I would expect punishment for an epileptic who is noncompliant with meds and kills someone because of a seizure while driving). A person has no control over whether they are an alcoholic, but they are responsible for what they do about it.

 

[QuikClot]

quikclot...
your post left me speechless;

That didn't last very long.

for the rest of you, i think that it's not a disease. our school requires us to sit in on an AA meeting in the back and observe the dynamics, and this is what engendered the discussion.

making it a disease allows them to admit they are powerless against it. the power to help them, therefore, is through God. i believe this is a scapegoat to lift blame off themselves to "relieve the pressures" of trying to quit and getting your motivation through friends, community, and, of course, the higher power.

Rather than musing about exterminating 15 million Americans (which you conclude, with apparent reluctance, is not the way to go) you might have laid out your experience and the feelings it caused up front, rather than make a bunch of vauge assertions and offensive remarks, then sit back and watch the fireworks.

It would have been better for me to respond to your statements in a more restrained way. For some of us, this is a very personal issue. You may or may not be aware of it, but your original post drips with contempt, disdain, and judgement. I reflected those sentiments right back at you, and for that I apologise.

but alcoholism isnt just abusing alcohol. the vast majority of those people were seriously very different. they had addictive personalities. they cant even take prescription drugs (bactrim even for a UTI) without abusing it. they were gamblers, heroin addicts, etc. every little thing they undertook, from poker, to blackjack, to heroin to orgies and swingers, they abused it and got out of control. so maybe there is something genetic.

but calling it a disease and claiming they are powerless on their own strips them of their own resolve to find it in themselves, and forces an outside source. this is not true as it IS entirely possible to cure yourself, as, of course, the cure lies within. they may look to god for strength, but its ultimately on them not to reach for the rum, no matter their reasoning.

So it would seem that your problem is not really that alcoholism is a disease -- you've basically argued yourself into admiting that it is -- but one specific thing that one specific group advises as part of a comphensive plan to put alcoholism in remission, namely steps one through three:

1.We admitted we were powerless over alcohol--that our lives had become unmanageable.

2.Came to believe that a Power greater than ourselves could restore us to sanity.

3.Made a decision to turn our will and our lives over to the care of God as we understood Him

You do not have to accept these steps as part of your care plan. Accepting them has nothing to do with whether we define alcoholism as a disease. You will not find them in the DSM. They are simply something that AA has found to be helpful to a lot of people. If you read the Big Book -- something I recommend to all future physicians -- you will find that even AA does not argue that these steps are the only road to recovery, merely that a lot of people have used them with success.

Diseases, as I and others have pointed out, are not things we are powerless over or not responsible for coping with. The ideas are not logically connected. You can accept the disease model of alcoholism without accepting the spirtual modality for recovery, which is, of course, exactly what the DSM and the medical profession mostly do.

So you can reject the AA approach, but you shouldn't. It's very powerful, and not at all about abdicating responsibility. Just the opposite, in fact. You could consider it a paradox -- in a spirtual program, you can have paradoxes. If you continue on to the next nine steps, a very different picture emerges:

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Does that sound to you like something you do if you've given up a sense of responsibility for your fate? What addicts call "turning it over" is about accepting a lack of control over our ultimate fate -- something that none of us have. It is different from not working on the problem yourself. AA has a saying that expresses this duality: "Not responsible for the results; only responsible for the leg work."

I hope you can hear these things from me, despite what I said above, because I believe them to be things really important for clinicians to know. I said, above, that I think you should have led with your experience. I also should have led with mine. My father was an alcoholic before his death last year of an MI. His elder sister was an alcoholic and a drug addict before her suicide. His younger sister is in AA, and his younger brother is dealing with a DUI and the loss of a relationship with his children, because of his drinking. Because of my father and the rest of my family, and because I recognise elements of the addictive personality within myself, I've chosen never to drink. What you said deeply offended me, because, even while asking for our opinions, you appeared to have already passed judgement on alcoholics, and reacted in an angry and contemptous way to them.

I know how quickly in an argument it ceases to be about information and becomes about winning. I hope that, even if you still think I'm a jerk, you'll consider my experience and look closely at the 12 step program, which is much deeper and more powerful than it might seem.

PS:

have you been to an AA meeting?

Oh, yes. The last meeting I went to was my father's first birthday. Do you know about AA birthdays? We celebrate the anniversary of someone's sobriety. My father had 495 days of sobriety when he died. After the meeting, he gave me his coin. Do you know about coins? A meeting gives out coins to mark sobriety dates, starting a 24 hours. One week, one month, three months, six months. The short-time coins are made of plastic but for a year, it's a real metal coin. That coin is the most precious thing I own. It's not even close. So, yes, I've been to an AA meeting. If you're ever in Portland, PM me and we can go to one together. Believe me, they look different from the inside.

 

[jdh71]

I just think your school failed you to some extent by introducing you to the topic via an unscientific, 12 step group. There is some value to knowing what an AA meeting is like, mostly for the purpose of ascertaining that there is nothing medical or scientific about it. It is essentially a form of religion. Don't mistake the views of AA as the mainstream medical establishment.

I find this sentiment a bit strange coming from a psychiatric professional, especially in light of what I experienced from my psychiatry rotation and psychopathology course. But I guess what am I supposed to expect from a pill-pushing, "sort-of" doctor . . .

AA works. It is emphatically NOT a religion, even if many within the rooms of AA treat the program as such. Bill Wilson recognized that the solution to the drink lie with the "spiritual" and you will probably not find a group more skeptical of organized religion than those in AA. The mental contstruct of a higher power, wether real in in actuality, is completely irrelevent because it works. There are millions and millions of people sober today because of the 12 step program of AA. And doctor's should not know about it? You have something better I assume? A pill perhaps? You ridicule what "can do" that you cannot, and call it "unscientific" . . . even though it works. What a strange sentiment . . .

The psychological construct for why the program works is pretty straight forward as well. You give the addict a hook upon which to hang their recovery and they start to work on all of their personality issues that necessitate the drink or the drug. Long term sobriety can be found in the rooms of AA because of AA. Other modalities may work, but nothing treats the real problem, except for AA, and the real problem lies within the thinking of the alcoholic.

 

[jdh71]

lakewood: if you get to medical school, or residency, or a profession of any kind, you'll soon realize its impossible to go to 90 meetings for 90 days and read the whole big book. we make judgements on what we see and what we know; its human nature, its universal, and its the best we can do with limited exposure.

I found the time . . . and you know basically nothing from one meeting

 

[leejosepho]

Is alcoholism a disease?

From “Alcoholics Anonymous”, the book, the original A.A. experience:

“[Doctor William D. Silkworth’s] theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.” (Comment made in “The Doctor’s Opinion”);

“An illness of this sort - and we have come to believe it an illness ...” (page 18);

“We alcoholics are men and women who have lost the ability to control our drinking ... We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better.
“We are like men who have lost their legs; they never grow new ones. Neither does there appear to be any kind of treatment which will make alcoholics of our kind like other men. We have tried every imaginable remedy. In some instances there has been brief recovery, followed always by a still worse relapse. Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn't done so yet.” (pages 30-31);

“If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic. If that be the case, you may be suffering from an illness which only a spiritual experience will conquer.” (page 44);

“...we have been not only mentally and physically ill, we have been spiritually sick. When the spiritual malady is overcome, we straighten out mentally and physically.” (page 44);

“[Dr. Bob] had [previously and] repeatedly tried spiritual means to resolve his alcoholic dilemma but had failed. But when [Bill W.] gave him Dr. Silkworth's description of alcoholism and its hopelessness, the physician began to pursue the spiritual remedy for his malady with a willingness he had never before been able to muster. He sobered, never to drink again up to the moment of his death in 1950.” (Foreword to Second Edition);

“All these [types of alcoholics mentioned], and many others, have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity. It has never been, by any treatment with which we are familiar, permanently eradicated. The only relief we have to suggest is entire abstinence.
“This immediately precipitates us into a seething caldron of debate. Much has been written pro and con, but among physicians, the general opinion seems to be that most chronic alcoholics are doomed.
“What is the solution? ...
“I earnestly advise every alcoholic to read this book through, and though perhaps he came to scoff, he may remain to pray.” (William D. Silkworth, M.D., 1939).
--end of excerpts--

A little over a quarter-century ago, an MSW working as an addictions counselor asked me whether I had a desire to stop drinking. Knowing that I absolutely could not stop ...

“There was a tremendous urge to cease forever. Yet we found it impossible. This is the baffling feature of alcoholism as we know it - this utter inability to leave it alone, no matter how great the necessity or the wish.” (page 34)

After twice avoiding his question, I finally I answered, “Yes, I want to, but I cannot. Why not?” He answered, “Because you are alcoholic.”

Point: Alcoholism does not have to be known as a disease in order for a professional to let an alcoholic know he or she has it. And of course, and quite obviously, neither would calling it a disease get in the way of that.

 

[leejosepho]

You must treat an alcoholic's drinking as a symptom of a disease.

“Certain drinkers, who would be greatly insulted if called alcoholics, are astonished at their inability to stop. We, who are familiar with the symptoms, see large numbers of potential alcoholics among young people everywhere. But try [to] get them to see it!” (pages 33-34);

“Far from admitting he was an alcoholic, [Fred] told himself he came to the hospital to rest his nerves. The doctor intimated strongly that he might be worse than he realized ... We told him what we knew about alcoholism. [Fred] was interested and conceded that he had some of the symptoms ...” (pages 39-40);

“Our liquor [drinking] was but a symptom ...” (page 64);

“Bottles were only a symbol.” (page 103).
--end of excerpts--

If alcohol is the source or cause of an individual’s problem, that problem will be gone when the alcohol is removed. For the alcoholic, however, the problem is the reality of sober living:

“I know I must get along without liquor, but how can I? Have you a sufficient substitute?" (page 152).