alcoholism-disease or not

[AFPheonix]

Will power does not override the fact that you experience some very real physical changes. It also ignores the very real mental and chemical changes in your body that are part of addiction.
Would you not consider chronic depression, schizophrenia, or other mental illnesses to be disease states?

[BlaqueKatt]

Would you not consider chronic depression, schizophrenia, or other mental illnesses to be disease states?

nope the they can and do go away without treatment, as a matter of fact schizophrenia is usually limited to a span of time 20's-40's usually. That and most mental illnesses are not fatal.

[Seshat]

Huge, huge jawdrop.

Are you aware that there is a measurable neurochemical, anatomical or neuroelectric difference between the neurotypical (what we'd call 'healthy') brains and the brains of people with (most) mental illnesses?

Okay. Before I go into a huge rant - are you simply using a narrower definition of 'disease' than I am?

I'm using 'disease' to include things like kidney failure, livers that can't process toxins correctly, malformed hearts, and (obviously) malformed or misfunctional brains and central nervous systems.

'disease' also (to me) includes things which will pass on their own - like infections such mumps, measles, chicken pox, polio and smallpox. Or problems like cancer - some of which do seem to go away on their own. (Others, of course, a more permanent.)

And things which have transient overt symptoms but which hang around for a while. Shingles, herpes, syphilis.

And things which stick around forever. Tuberculosis being one example.


If you are simply defining 'disease' more narrowly, please let us know. But if you genuinely think people with mental illness simply aren't sick - well, I totally, completely disagree with you!

An addiction you have control over it: it's called WILL POWER.

This does not apply to most of the cases I described earlier, where alcoholism is a symptom of a greater problem. For the most part, those greater problems are not solveable just by application of will - therefore even if they stop drinking, some other symptom will show up.

In those cases, the greater problem needs to be fixed.

[Boozy]

nope the they can and do go away without treatment, as a matter of fact schizophrenia is usually limited to a span of time 20's-40's usually. That and most mental illnesses are not fatal.

I have never heard "disease" defined like this before, and I can't find any definition on the net to back this up.

There are thousands of conditions that are medically classified as diseases that a) can "go away without treatment", and b) are not fatal.

And for the record, untreated schizophrenia has a 30% mortality rate. The brain turns against the body and convinces the sufferer to kill themselves.

[AdminAssistant]

This does not apply to most of the cases I described earlier, where alcoholism is a symptom of a greater problem. For the most part, those greater problems are not solveable just by application of will - therefore even if they stop drinking, some other symptom will show up.

In those cases, the greater problem needs to be fixed.

Exactly Seshat. My father is an alcoholic. He stopped drinking for...oh, about 15 years. Guess what? He started abusing painkillers, antidepressants, and Xanex, and was aided by an enabler, pill-pushing doctor who I would personally love to meet in a dark alley with a baseball bat. Things were okay for a little while. Until a few years ago when things got really out of hand and he added sleeping pills to the mix.

We have finally got most of his pills taken away from him. Dr. SucksaLot has retired, every new doctor trip Mom goes with Dad to insist that the nurses put on his chart that he can't have refills before the time is up. Every doctor is told about his problems. Both pharmacies in town know.

So...he started drinking again. He uses it to get away from a life he never wanted to live, responsibilities he didn't want to take, and from the fact that they should really get a divorce, but won't for whatever reason. And I don't go home nearly as often as I used to, because I just don't want to deal with it anymore.

[BlaqueKatt]

Huge, huge jawdrop.

Are you aware that there is a measurable neurochemical, anatomical or neuroelectric difference between the neurotypical (what we'd call 'healthy') brains and the brains of people with (most) mental illnesses?

Okay. Before I go into a huge rant - are you simply using a narrower definition of 'disease' than I am?

Using the dictionary definition and the criterion for medical diagnosis of disease:
* Primary

* Progressive

* Chronic

* Fatal

Plus mental illness is NOT diagnosed by checking for brain abnormalities*-it's pretty much a crapshoot or "guessing game" if you will-I know as I was erroneously diagnosed as bi-polar when in fact I have autism, I have a friend who was diagnosed as schizophrenic-and was not-we were both given medications that did more harm than good, as the "guesses" of the "medical professionals" we saw were incorrect-had we been checked for brain abnormalities we would've been spared years of additional suffering caused by the medications we did not need. I also know people who have been given antidepressants by their regular doctors without ever having seen a therapist or psychiatrist, do they really need them or do they just maybe need someone to talk to?(or maybe there is something else medically wrong-a vitamin B deficiency can cause feelings of depression or guilt) as far as 30% of untreated schizophrenics committing suicide- I have migraines-which are classified as a disease-if I decide to off myself because the pain of a migraine does that make migraine disease fatal? If not why does it make any other disorder fatal?


Also keep in mind the US is the ONLY country that believes alcoholism/addictive behavior is a disease-we are also one of few countries without national health care-hmmmm-think money might be a factor there?

I found two excellent articles on addiction/alcoholism and genetics-I highly recommend the first
Here

The disease concept strips the substance abuser of responsibility. A disease cannot be cured by force of will, therefore, adding the medical label transfers the responsibility from the abuser to others. Inevitably they become unwilling victims, and inevitably they take on that role.

In retrospect then, the disease concept has effectively increased alcoholism and drug abuse. Furthermore, its only benefit has been vast monetary reward for the professionals’ and governmental agencies responsible for providing recovery services. Specifically, it has not offered a solution for those attempting to stop abusive alcohol and drug use.

"A natural assumption would be that the classification of a disease requires that characteristics and symptoms can be measured or observed.

While the majority of diseases fit this requirement, substance abuse does not.

The contradiction to these requirements lies within the defined nature of “alcoholism.” This supposed disease’s symptoms are only discovered after the consumption of alcohol. The health risks, dangerous behaviors and repercussions only materialize after the alcohol is consumed and not before.

In comparison, the diagnosis for cancer comes after symptoms surface or cancerous cell are discovered. There are physically visible anomalies that can be measured. This measurement does not exist with alcoholics. The majority of time, the diagnoses of alcoholism is a guess, if indeed such a diagnosis actually exists.

There is little question that a person exposed to carcinogens or radiation will eventually get cancer.

With alcohol it is questionable if a person will become a problem drinker if exposed to alcohol. While cancer is a separate entity of its own within the body that first exists without the knowledge of its host, over consumption of alcohol, a substance consumed by choice, is necessary before a diagnosis can be made.

That is to say that one must choose to create the condition before the condition can be diagnosed."

and here

Researchers now have identified over a thousand genes linked to alcoholism. The genetics of alcoholism mirrors what has become increasingly apparent to geneticists: life is complicated.

The way you act or the quality of your health is likely influenced by many genes interacting with each other along with various environmental factors. The concept that a small number of genes are responsible for disease or behaviour is obsolete.

What that means, in the case of alcoholics or drug addicts, is that even if your parents were addicted, it's unlikely that their genes are the deciding factor that will make you an addict.

But many people still hold the outdated, simplified view that key genes "cause" most disease and addiction.


*the way most mental illnesses are diagnosed and treated would be akin to diagnosing and treating someone for diabetes based on the fact that they drink a lot of water and pee a lot. They're diagnosed by a list of symptoms, not any actual evidence of anything being "wrong" or "malfunctioning" which is why most people being treated for depression change medications/dosages multiple times before finding something that actually works.

[BlaqueKatt]

there's also this:

It is speculated that the disease concept originated in the 1800's with a fellow by the name of Dr. Benjamin Rush. He believed alcoholics were diseased and used the idea to promote his prohibitionist political platform.

He also believed that dishonesty, political dissention and being of African American decent were diseases as well. The “disease concept” was used throughout the late 1800’s and early 1900’s by prohibitionists and those involved in the Temperance Movement to further a political agenda.

Prior to this time, the term alcoholic did not exist. Alcohol was freely consumed but, drunkenness was not tolerated.

Many sociologists contribute its non-existence to the very stigma the disease concept removes. In fact, “Despite an ardent search, however, temperance adherents never identified an account of a drunkard before the 1800’s who reported that he has lost control of his drinking.” (Stanton Peele “Diseasing of America” pg 37)

Today, Jellinek’s “Stages of the Alcoholic” is still widely used to diagnose substance abusers. But, these stages are based on a corrupt study that the author, himself, later refuted. Jellinek not only published a fraudulent study, he defrauded members of his academic community, and apparently lied about his educational background to gain acceptance.

Nonetheless, it was Jellinek’s “Stages of the Alcoholic” that led to diagnosing alcoholism as a disease and eventually to the medical acceptance of alcoholism as a disease. Astoundingly, the inception of the current disease and treatment paradigm is based on fraud.

[Boozy]

as far as 30% of untreated schizophrenics committing suicide- I have migraines-which are classified as a disease-if I decide to off myself because the pain of a migraine does that make migraine disease fatal? If not why does it make any other disorder fatal?

Do your migraines create an overwhelming compulsion to kill yourself? Or convince you that you can fly, so you jump off a building? Of course not. I think it's cavalier and hurtful to dismiss schizophrenic suicides as "choices".

[BlaqueKatt]

Do your migraines create an overwhelming compulsion to kill yourself? Or convince you that you can fly, so you jump off a building? Of course not. I think it's cavalier and hurtful to dismiss schizophrenic suicides as "choices".

re-read my post-I was giving the definition I use for disease-the medical criterion that have to be met-mental illness does not fit as it's not fatal. Suicide is NOT part of the disease, people commit suicide in the absence of mental illness-I was responding to the inevitable objection/argument of "well they commit suicide-so it is fatal"


and according to schizophrenia.com the majority of suicides are due to the depression the disorder causes-not a delusion, and yes migraines can cause depression as well, lots of things can.

[Seshat]

The disease concept strips the substance abuser of responsibility. A disease cannot be cured by force of will, therefore, adding the medical label transfers the responsibility from the abuser to others. Inevitably they become unwilling victims, and inevitably they take on that role.

Okay. I disagree with a bunch of stuff in your post, but given your experiences with psychiatric treatment, I can understand why you believe them. My experiences have been very different.
Besides, this isn't a psychiatry thread, it's an alcoholism thread. So I'll address alcoholism and the disease concept.


In my experience, and my part of the world, labelling something 'a disease', or even 'disease (blah)', says nothing at all about responsibility, or curability, or treatability. All it provides is a way of categorising a problem - and identifying which treatments/cures have worked in the past for that problem.

My best friend's neurochemical faults are a problem. Disease or not, they're a thing she simply has to cope with. She has no choice. Without medication, her life is a living hell. With medication, it's less of a hell.
She and her closest friends (my husband and I) have to monitor her emotional state, and when things are going badly, we have to use all the willpower-y techniques.
Only if they fail, do we pull out the chemical methods of 'solving' it, because (quite frankly) the side-effects are awful.
Managing her illness is her responsibility, with the support and willing help of her closest friends.

My own pain-based problems are also a disease state where I am responsible for managing it. With the support and willing help of my husband and my best friend. (Yes, we're mutual carers.)


No, neither of our problems can be cured by force of will. With current knowledge, they can't be cured at all. But we are responsible for our treatments - not doctors. Doctors can't 'make us better', they can only provide knowledge of what has worked for others, and perhaps drug, surgical or other therapeutical treatments.

So yeah... I disagree that calling something a 'disease' means responsibility lies with others. It's your body, it's your problem. Not anyone else's.

[BlaqueKatt]

In my experience, and my part of the world, labelling something 'a disease', or even 'disease (blah)', says nothing at all about responsibility, or curability, or treatability. <snip>
So yeah... I disagree that calling something a 'disease' means responsibility lies with others. It's your body, it's your problem. Not anyone else's.

except when dealing with alcoholism

the first "step" for an alcoholic in any 12 step recovery program(and one is hard pressed to find any treatment that is not 12 step based)-the first thing you are told in your first meeting is:

"we admitted we were powerless against alcohol"

They actually tell you if you quit going to meetings-you will relapse-because it's a disease you have no control over.
They also tell you "you will never be cured" because its a disease.

Remember AA is the main pusher of the disease theory of alcoholism. Does that sound like "taking responsibility"?


the AA program has not changed in over 70 years, and they have a 3% success rate, Dr Stanton Peele expert in addictive behaviours says 30% of alcoholics quit on their own with no help, compare that to non-12 step programs where they emphisize choice and personal responsibility-they have an 86% success rate, even after 10 years following treatment.

[AFPheonix]

Many addiction specialists out there espouse the disease theory, mostly because of the genetic links that have already been gone over several times in this thread.

AA is only one route of treating alcoholism. They are not the end-all be-all, there are quite a few other programs.
It's also kind of a cultural thing. How Americans deal with addiction can be very different from how a European deals with an addiction to alcoholism.
Just because one program may not be your cup of tea doesn't mean that they are completely wrong. I frankly don't care for the religious overtones of AA, but that's just me.

[BlaqueKatt]

It's also kind of a cultural thing. How Americans deal with addiction can be very different from how a European deals with an addiction to alcoholism.

And from everything I've read about it America is the ONLY country that believes the "disease theory"-and it is merely a theory-it was declared a disease in the absence of any hard medical evidence-back in the 1800's by a man that considered being of African descent(dark skin) a disease. When the AMA accepted it as a "disease" they made the decision under pressure from AA.

Just because one program may not be your cup of tea doesn't mean that they are completely wrong.

It's not that they're not "my cup of tea"-it's the lousy 3% success rate. If you needed treatment for something would you go somewhere with that kind of success rate that keeps claiming "it works if you work it"-over 95% of the treatment programs available in my state are 12 step programs that don't work-and everyone wonders why WI has a drinking problem.

I frankly don't care for the religious overtones of AA, but that's just me.

it's not just "overtones" it fits the basic premise/guidelines of a cult-and at least in the US you cannot be ordered by a judge to attend AA meetings as that was found to be in violation of the first amendment.

[AFPheonix]

And from everything I've read about it America is the ONLY country that believes the "disease theory"-and it is merely a theory-it was declared a disease in the absence of any hard medical evidence-back in the 1800's by a man that considered being of African descent(dark skin) a disease. When the AMA accepted it as a "disease" they made the decision under pressure from AA.

For starters, a theory is a set of hypotheses that have held up to testing. "Merely" a theory is kind of a misnomer in scientific vocabulary. It's a GOOD thing to reach theory status, that means it's a supported idea.
As for Europeans not treating alcoholism as a disease, are you sure about that? A quickie google search turns up quite the opposite.
Here's one that actually says "Alcohol addiction is a disease"

"...to give you more information on the illness of addiction and its many manifestations."

And those are just a few of the many sites that came up with that sort of message.
There were many sites that were directories for medical care providers and inpatient services, which makes me think they utilize the disease model of addiction treatment.

It's not that they're not "my cup of tea"-it's the lousy 3% success rate. If you needed treatment for something would you go somewhere with that kind of success rate that keeps claiming "it works if you work it"-over 95% of the treatment programs available in my state are 12 step programs that don't work-and everyone wonders why WI has a drinking problem.

Not sure where the 3% number is coming from, Betty Ford clinic points to a much higher number. Again, 12 step isn't for everyone. That's fine, everyone's wired a bit differently. For a full third of patients that go through them, it apparently is affective, and that is statistically significant.

it's not just "overtones" it fits the basic premise/guidelines of a cult-and at least in the US you cannot be ordered by a judge to attend AA meetings as that was found to be in violation of the first amendment.

Having dealt with my BIL, I know that there are less Christian AA groups out there. Some are downright militant evangelists, but there are more Unitarian versions too. It's really dependent on the group. Again, if a person happens to be theistic, then this may be a good framework for them to work in. An atheist they should probably look elsewhere for support.

Addiction medicine is still pretty young, and it doesn't have all the answers yet. A lot of it has to do with the fact that we frankly are still pretty new at the whole brain thing, too. It will probably be decades before we really understand a lot of the stuff that we're only just starting to discover now. Hell, there's cells in your nervous system that we don't even know the function of yet. It just takes time and trial and error. In the meantime, if AA or cognitive behaviour therapy or Antabuse works for someone to get their lives back together, then more power to them.