42. Is alcoholism really a "disease"?

By Tom O'Connell

If an alcoholic chooses to do something self-destructive, how can alcoholism be a disease? Well, try these questions on for size. If you choose to overwork and get a heart attack do you have heart disease? If your lifestyle leads to ulcers do you have a disease of the stomach? Have your personal choices or compulsions led you into sexually transmitted diseases?

Many people remain skeptical about the "disease" concept of alcoholism because they think drinking too much is a moral problem based on a lack of will power. But even though moral problems enter into the situation, as with many other diseases, it is valid to think of alcoholism as a disease process.

Earlier in this century, the subject was often debated in medical circles. But in 1956, the American Medical Association (AMA) called alcoholism an "illness." Then, in 1966, AMA recognized that alcoholism was a "disease." Finally, in a major breakthrough in medical thinking, during June 1987, the AMA declared that "drug dependencies, including alcoholism, are diseases, and that their treatment is a legitimate part of medical practice."

Dorland's medical dictionary defines "disease" as "any variation from, or interruption of, the normal structure or function of any part, organ or system, or combination thereof, of the body, that is manifested by a characteristic set of symptoms and signs; whose etiology (cause), pathology (condition produced by disease), and prognosis (symptoms indicating the course of a disease), may be known or unknown."

Alcoholism, and the other addictions, fit this definition. Alcoholism interferes  with the normal function of the body. It has a set of causes. It has easily recognized symptoms. People suffer and die from it. And it has a predictable course. Alcoholism is a disease.

There are other simpler definitions of addictive disease too. For example, "a condition of unhealthy dependence which impairs a person's ability to function to full potential." And another is, "a disease in which any technique for adapting to the problems of life is used other than healthy interpersonal relating."

Based on 20 years of writing about this subject, and listening to a wide variety of experts, my own view is that addiction is a "biopsychosocial disease process with important spiritual connections." It fits all of the definitions we have used in this article. It involves the whole person. Its roots may be in allergy, genetics, stress, decline of values, peer pressure, cultural standards, or simply habit. It affects one's entire lifestyle and becomes the central focus of thought and activity.

Alcoholism and the other addictions, whether they involve substances or various  behaviors, are reflected in the functions of the body, the mind, social interaction, and one's spiritual condition.

In a word, addiction is "complex," not simple. So simple-minded approaches to remedies miss the mark. For example, quitting drinking is only the first step in a long recovery process. Then the person, in AA or elsewhere, needs to embark on a long-term program of character training, physical recovery, mental and emotional healing, social skill development, and spiritual growth.

Is alcoholism a disease process? Yes. Is it complex rather than simple? Yes. Is there hope for recovery no matter how far down the scale of severity a person has gone? Yes. Many addicted people have experienced recovery against great odds. And Alcoholics Anonymous, the original Twelve Step Program of recovery, has guided millions through recovery and has provided a model that has given rise to many other mutual help groups.

How do these programs work? As one member of AA said a long time ago, "Just fine, thank you."

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