Is Alcoholism really a disease?
As far back as anyone alive today can remember, alcoholism and drug addiction has been a polarizing issue. Is it a choice, a personality defect? Or is it a disease, which requires professional treatment? I recently came across an interesting article in the New York Daily News. It details a conversation about whether or not alcoholism is a disease. To this author, it seems archaic to think that the disease model of addiction is still up for debate. However, the dialogue below illustrates the mindset of many.
I've posted it here:
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DR. DAVE: What did you tell her?
BILL: Well, Dave, she caught me in a kind of moral bind. I have nothing against calling alcoholism or drug use a disease. Shame and guilt never got anyone sober. But I prefer the term "addiction" - maybe it’s deadly, but you did it to yourself. You didn’t catch it by kissing the bartender. So let me turn the question around. Why do you call it a disease?
DR. DAVE: In l956, the American Medical Association officially said alcoholism met three standard criteria for being declared a disease. First, it had an identifiable set of symptoms. Second, it followed a predictable and malignant progression if not treated, and third, it did respond to treatment. What this meant was that the insurance industry - not markedly a bastion of politically correct blue sky crap - agreed to pay for treatment, just as if you came down with diabetes.
Today, Disease Concept Treatment, or “DCT," is the overwhelming therapy of choice in the health care professions. On top of that, ongoing research studies in top line medical journals consistently show that DCT outperforms other approaches.
BILL: But Dave, even Alcoholics Anonymous itself says alcoholics suffer from a “character defect.” What’s so scientific about that? Doesn’t that sound like we suffer from a moral flaw, a weakness of will power and/or character?
DR.DAVE: I’ve learned never to get into an argument with any of you AA Big Book Thumpers when you quote steps to me. The actual language is a mish-mash of Jungian psychology, the Episcopal Church and 100 newly sober Midwestern drunks. Bill, your quote from Step Six has no medical meaning.
BILL: Doc, you just made my point. If the 12 Steps of AA are not medical science, why should anyone enter a long-term counseling program built on this Midwest spiritual beef stew model?
DR. DAVE: Well, let’s put the argument in terms of everyday life.
BILL: Where wives like Louise finally tell the drunk husband, “We all love you, but your boss is going to fire you and I am taking the kids and filing for divorce - unless you go to rehab for alcoholism.”
DR. DAVE: Right. Now, let's say I have 904 spouses and/or employees just like Louise and her husband. And after rehab, I require all of them to continue to go to AA meetings, weekly aftercare counseling and submit to random urinalysis.
BILL: And if they drink or use, they are fired on the spot?
DR. DAVE: No, we know at least 10% will relapse and need longer or more intensive treatment.
BILL: Most of whom - I remember from my days working at a rehab - would welcome help so as not to lose family or jobs
DR. DAVE: Right. Now, after 5 years, how many of the 904 do you think would successfully complete their treatment - following weekly health counseling and whatever you want to call AA meetings?
BILL: Five years? I have heard most programs are lucky if half are still in recovery after six months! Hardly a kind of medical treatment I would be proud of.
DR. DAVE: Whoa there, the right answer is that over 75% are in recovery. That statistic comes from the McClellan Study and was done on a national sample between 2000 and 2007.
BILL: Impressive! But let’s go back to where we began: What is there about this study of 900 drunks that would lead Louise (or me) to believe that requiring rehab, AA and group counseling is a scientifically valid medical decision?
DR. DAVE: Because those 904 drunks and drug addicts came from referral programs in 49 states - and every one of them was a physician going through their state’s required medical intervention process. I don’t think the definition of a medical program can be any better than one wherein all the subjects are physicians and surgeons themselves.
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It's a shame that everyone who perpetuates the stigma of addiction, due to a lack of understanding, doesn't have Dr. Dave to patiently educate them on the disease of addiction. Treatment isn't our only challenge, awareness and education are paramount in the bigger-picture battle against this complex disease.