Further Reading

Shouldn't we treat alcoholism as a disease?

Dear Stanton:

Is alcoholism a disease? At a bar association seminar we were told that alcoholism is (a) a disease (b) "treatable like a disease", and (c) a "disease based concept". I have friends at CDC who say that there is not a consensus in the medical community for the "alcoholism is a disease" statement as a fact, but that it is an approach to treatment.

The consensus seems to be that it is better to treat alcoholism as a medical problem than as a legal problem. I can assure you that no one is cured of anything by standing in front of a judge for 15 minutes for sentencing. It seems that few are cured of anything by being imprisoned for days, weeks, months, or years without treatment. Can you direct me to an official source for the answer to my question: "Is alcoholism a disease?"

Richard

PS: The lecture was being given by employees (MD) of a private alcohol treatment center. Thanks! Rich.


Dear Richard:

I am the "antichrist of the recovery movement," so what you'll hear from me is that alcoholism is not a disease. But the Bar Association should be ashamed of itself for presenting this view with no counterpoint, presented by people who profit from selling this bill of goods. Attorneys, one would hope, would be somewhat skeptical about the goals of private treatment personnel in claiming this was the case (you, for one, seemed to be).

  1. Nearly all lay people in the U.S. agree that alcoholism is a disease, because that's what is taught in school. But, although 90% of Americans agree with the idea, what this agreement means to them varies all over the place. This depends on personal attitudes and cultural background, among other things. Almost no researchers would simply assent to the idea that alcoholism is a disease, although some are in sympathy with the thrust of this approach. The people who most spiritedly promote alcoholism-as-a-disease are staff at private treatment centers and the small minority of all alcoholics who recover through AA. (You should examine my book, "Diseasing of America.")
  2. Alcoholism is not a disease. To an extent, it is arbitrary whether it is called a disease or not. However, everything disease advocates mean to indicate by this label is wrong, to wit (a) the genesis of alcoholism is biological and is inherited, (b) alcoholism follows a set pattern, inevitably progressing from bad to worse, (c) we have treatments (medical in nature) that deal effectively with this disease, and so on. My site is filled with material to show these assumptions are wrong. (See my on-line library, "The Disease Theory of Alcoholism" and "Genetic Models.")
  3. More critically, treating alcoholism as a disease has a negative impact. Those cultures that most regard alcoholism as a disease have the highest alcoholism rates (see my article "A moral vision of addiction"). Treatments geared towards alcoholism as a disease have uniformly the worst success (see my article, "Recovering from an all-or-nothing approach to alcohol").
    This is because they ignore individual differences and motivations and sell patients a bill of goods (based primarily on the treatment staff's personal experiences). That we continue to sell this failed product as a modern scientific advance is a tribute to long-standing American attitudes that grew up during temperance, which laid the groundwork for the American view that alcoholism is inbred and uncontrollable and that abstinence is the only answer to alcohol problems.
  4. You correctly indicate that judges sentencing people for substance abuse is pretty futile. But not quite as futile as treating them. A number of studies, including a government sponsored trial of court interventions, have found that DWI defendants and street inebriates sentenced to treatment and or AA fare worse than those given judicial sanctions! (My article, "Research issues in assessing addiction treatment efficacy: How cost effective are Alcoholics Anonymous and private treatment centers?" Drug and Alcohol Dependence, 25, 179-182, 1990, will be put on-line some time this year.)
  5. What is more, these coercive policies, and particularly forcing sentencees and inmates to attend AA, have been uniformly found to be unconstitutional (the latest such case to attract attention was in New York). Yet, the majority of those entering treatment are under some compulsion to do so, through EAPs, Medicaid or other government social services program, or court order (both civil and criminal). There is no possibility of reversing this, because it satisfies both hardliners who favor criminal justice solutions and softliners who feel treatment is best <my article, "AA Abuse," will be put on-line soon). The ABA has been among those most active in advocating greater treatment and greater coercion into treatment. A special 1994 report it issued made no mention of constitutional questions while espousing greatly expanded coercive treatment (see my book chapter, "Assumptions about drugs and the marketing of drug policies").
  6. We have a sorry state of affairs, to which the legal system is contributing greatly, which forces disease treatments on people in a way that is both ineffective and unconstitutional.

Sorry to give you the bad news,

Stanton