Disease of Alcoholism

The disease model of alcohol abuse is widely accepted but is controversial in many circles. Opponents claim it relieves the problem drinker of any responsibility for their alcohol abuse and related consequences. Proponents claim it has its advantages which are described in more detail below.

A person with the “disease” of alcoholism has been labelled an alcoholic. Nevertheless, the term alcoholic has been widely applied to many who abuse alcohol but may not necessarily have the disease. For this reason it may be helpful to define an alcoholic as “a person who is physically and emotionally addicted to alcohol”. But let us turn our attention to why alcoholism may be considered a disease.

Alcoholism is now commonly regarded as a chronic and potentially fatal condition that pays little respect to strength or weakness of character. The disease concept holds that addicts have inherited maladaptive biochemical responses to certain chemicals.

Research studies indicate that regardless of environmental influences the biological children of alcoholics – even when their adoptive parents abstain from drinking – are more likely to become alcoholics than are the children of non-alcoholics. The child of two alcoholic parents is reported to have a four times greater likelihood of becoming an alcoholic than is the population norm.

The genetic basis for alcoholism has been traced to the deficiency of an enzyme (aldehyde dehydrogenase) necessary for the body’s disposal of alcohol. Enzymes are the proteins in our body responsible for the breakdown or metabolism of drugs. They bring about a change (usually an increase) in the speed of bodily processes. Any aberration or alteration in those enzymes involved in the metabolism of alcohol or drugs is reflected in the way the body disposes of the drug. The enzyme’s dysfunctional response to the addict’s chosen drug is at the core of the concept of inherited addictive disease. Nevertheless, it is important to remember that although genetics help to render an individual more susceptible to a dysfunctional response to alcohol or drugs, it is not to be assumed that this is a predetermined dysfunction.

The notion of addiction as a life-threatening disease originated with E. M. Jellinek who in 1951 advanced the position that alcoholism is a progressive and potentially fatal disease, with identifiable signs and symptoms. This disease model of alcoholism has been embraced by Alcoholics Anonymous (AA), the National Council on Alcoholism, the National Institute on Alcohol Abuse and Alcoholism, and the American Medical Association.

In the words of alcoholism authority, George Vaillant, “Alcoholism becomes a disease when loss of voluntary control over alcohol consumption becomes a necessary and sufficient cause for much of an individual’s social, psychological and physical morbidity.” In other words, the alcoholic cannot always control when he or she starts or stops drinking. His or her life then becomes unmanageable, with or without the bottle.

Recently the disease concept has been expanded to include overeating, gambling, promiscuity, and nearly all forms of addictive and compulsive behaviour.

As previously noted, the idea of addiction as an illness has been criticized as it is said to diminish personal and social responsibility. Norman Zinberg of the Harvard Medical School succinctly stated, “The disease model is good for treatment but bad for prevention.”

Whether you agree with the disease concept or not, this model has helped an otherwise marginalized population enter treatment for their problematic dependencies. When loss of control is attributed to biochemical irregularity rather than moral depravity, addicts can acknowledge problems that they previously denied. They are willing to admit to addiction as a disease, largely because the stigma of being mentally deranged or ethically blameworthy is no longer a part of problem recognition.

Reference: Milkman, Harvey B. & Sunderwirth, Stanley G. (1987). Craving for Ecstasy. San Francisco, CA: John Wiley & Sons, Inc. (Pages xvi, 14, 15, 68, 69, 165)