Disease theory of alcoholism

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The Disease theory of alcoholism states that alcoholism is a disease process. The disease theory is generally accepted by the medical community^{[citation needed]}. Outside the medical community, there is considerable debate over whether or not alcoholism should be considered a disease. Proponents argue that genetic, neurological and behavioral studies distinguish those with alcohol dependence from problem drinkers. Opponents cite the inability to pin down the behavioral issues to a physical cause as a reason for avoiding classification.

Most medical clinicians consider alcoholism a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control and preoccupation with and use of alcohol despite adverse consequences^{[citation needed]}. However, the disease theory is still controversial among the public at large. US Supreme Court decisions, books, and scientific journal articles demonstrate this lack of consensus.^{[1] [2] [3] [4] [5] [6] [7] [8] [9]}

Contents 1 Theory 1.1 Controversy 2 History 2.1 Current acceptance 3 Medical evidence 3.1 Supporting evidence 3.2 Dissenting evidence 4 References 5 External links

Theory

The term "disease" refers to a disorder of structure or function. The term can refer to a physical disorder, such as diabetes, or to a mental disorder, such as schizophrenia. Diseases can be short-lived, such as the common cold, or life long, as in sickle cell anemia.

In the case of alcoholism, research has demonstrated both genetic and environmental contributors to the development of a condition that carries significant physical morbidity. Such factors as a typical course and well-described epidemiology (the incidence and prevalence of the condition) also contribute to the establishment of a disease entity.

Controversy

Some argue that the disease concept is promoted by those with a vested interest: If alcoholism is not considered a disease, third-party payments to physicians and hospitals for its treatment might cease.

History

The disease theory of alcoholism was first proposed in the early 1800s by Dr. Benjamin Rush of Philadelphia, and independently by Thomas Trotter^[10]. The modern theory of alcoholism as a disease was put forth by E. Morton Jellinek. Controversy over Jellinek's claim that he received a doctoral degree ^[11] has contributed to criticisms of the disease theory.

The first challenge to the disease model came with the publication of D.L. Davies' (1962)^[12] follow up of seven alcohol abusers which found that some of them were able to revert to "controlled drinking." Although the data has subsequently been challenged, it caused a storm at the time by asking how someone suffering a disease which reputedly leads to uncontrollable drinking can manage to drink controllably. Subsequent studies also found similar results^{[citation needed]}.

Between 1980 and 1991, medical organizations worked together to establish policies regarding their positions on the disease theory. These policies were developed in 1987 in part due to the lack of parity between addictive disease and other chronic disease states with respect to third-party reimbursement. The policies of the American Medical Association, formed through consensus of the federation of state and specialty medical societies within their House of Delegates, state, in part: "The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice." In 1991, The AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections. In 1980, the AMA's Council on Scientific Affairs (now the Council on Science and Public Health) noted that "alcoholism is in and of itself a disabling and handicapping condition."

In a 1988 US Supreme Court decision on whether alcohol dependence is a condition for which the US Veterans Administration should provide benefits,^[13] Justice Byron R. White's statement echoed the District of Columbia Circuit's finding that "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility." He also wrote, "Indeed, even among many who consider alcoholism a "disease" to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary."^[13]

Current acceptance

The American Society of Addiction Medicine and the American Medical Association both maintain extensive policy regarding alcoholism. The American Psychiatric Association recognizes the existence of "alcoholism" as the equivalent of alcohol dependence. The American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify "alcoholism" as a disease.

Programs such as Rational Recovery reject the "disease model" and Stanton Peele has devoted a significant portion of his web site to disputing many assertions made by many in the alcoholism treatment community including the AMA, APA, and NIAAA.^[14]

The US Social Security Administration no longer makes disability payments to individuals for whom substance use disorders are a material aspect of their disability.

Disease theory of alcoholism was referenced in the South Park episode "Bloody Mary", with the character Stan Marsh saying "No, cancer is a disease. My dad needs to drink less." The episode had a lot of controversy, however that was all regarding the episode's portrayal of the Virgin Mary.

Medical evidence

The results of medical research have been used both in support of and against the disease theory of alcoholism.

Supporting evidence

Medication has been developed to assist in the treatment of alcoholism, although research has not yet demonstrated long-term efficacy.^{[citation needed]}

Research^[9] shows that frequency and quantity of alcohol use are not related to the presence of the condition; that is, people can drink a great deal without necessarily being alcoholic and alcoholics may drink minimally and/or infrequently.

Dissenting evidence

Research^[12] has shown that some recovered alcohol abusers can resume "controlled drinking." However, the data in this study has been challenged^{[citation needed]}.

References

1. ^ Maltzman I Is alcoholism a disease? A critical review of a controversy Integr Physiol Behav Sci 1991 Jul-Sep;26(3):200-10
2. ^ Levy MS The disease controversy and psychotherapy with alcoholics J Psychoactive Drugs 1992 Jul-Sep;24(3):251-6
3. ^ Schaler, Jeffrey A. Thinking About Drinking: The Power of Self-Fulfilling Prophecies The International Journal of Drug Policy Volume 7, No. 3, 1996, pp. 187-192
4. ^ Thomas R. Hobbs Managing alcoholism as a disease Physician’s News Digest, February 1998
5. ^ Roger E. Meyer The disease called addiction: emerging evidence in a 200-year debate
6. ^ Gina Kolata Alcoholic genes or misbehavior? The Supreme Court is due to decide on whether alcoholism is a disease or a character flaw Psychology Today May 1988
7. ^ Nackerud, Larry The disease model of alcoholism: a Kuhnian paradigm Journal of Sociology & Social Welfare 6/1/2002
8. ^ Doug Kelley Understanding the Nature of Alcoholism November 2001
9. ^ ^{a b} Article in the Journal of the American Medical Association, by the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine. 1992.
10. ^ Trotter T An Essay, Medical, Philosophical, and Chemical, on Drunkenness and Its Effects on the Human Body (1804) Tavistock Classics in the History of Psychiatry Edited by Porter R. London, Routledge, 1988
11. ^ Jellinek's Phantom Doctorate
12. ^ ^{a b} Davies, D.L. (1962). Normal drinking in recovered alcohol addicts. Quarterly Journal of Studies on Alcohol 23, 94 - 104.
13. ^ ^{a b} TRAYNOR v. TURNAGE, 485 U.S. 535 (1988)
14. ^ The Stanton Peele Addiction Website

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