Disease theory of alcoholism

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The Disease theory of alcoholism is generally accepted by most members of the medical community. Outside the medical community, however, there is considerable debate over whether or not alcoholism should be considered a disease. Proponents argue that any physical ailment should be classified as a disease. 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 an addiction and 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. However, the disease theory is still controversial and there is disagreement on the issue after 200 years of debate. U.S. Supreme Court decisions, books and scientific journal articles demonstrate this lack of consensus.^[1] ^[2] ^[3] ^[4] ^[5] ^[6] ^[7] ^[8] ^[9]

1 The disease hypothesis
- 1.1 Pro
- 1.2 Con
2 Miscellaneous
3 References
4 External links

[edit] The disease hypothesis

The following subsections outline arguments for ("pro") and against ("con") alcoholism as a disease.

[edit] Pro

The term "disease" refers to a disorder of structure or function. The term can refer to a physical disorder, such as a bone broken in an accident or diabetes, or to a mental disorder, such as schizophrenia. Diseases can be short-lived, such as the common cold, or lifelong, 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.

There was significant controversy regarding alcoholism's status as a disease in the past. As a result, medical organizations worked together to establish policies regarding their positions on this issue. 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.

The AMA's policies, 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." This policy was 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. 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."

Although medication has been developed to assist in the treatment of alcoholism, the research has not yet demonstrated long term efficacy. Of importance is that frequency and quantity of alcohol use are not related to the presence of the condition (definition, as per 1992 JAMA article cited above); that is, individuals can drink a great deal without necessarily being alcoholic, and alcoholics may drink minimally and/or infrequently. Alcohol is cross-tolerant with other sedatives such as Valium, Phenobarbital, and Soma. These other sedative agents are therefore generally not prescribed to individuals with alcoholism.

[edit] Con

Whether or not alcoholism is a biological disease remains controversial. The hypothesis has yet to be supported to the satisfaction of the alcoholism research community (Research Society on Alcoholism; American Psychological Association), although it is widely believed by AA members, therapists, many practicing physicians, and others. The first challenge to the disease model came with the publication of DL Davies (1962)^[10] follow-up of seven alcoholics 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 the question how could someone suffering a disease which reputedly led to uncontrollable drinking manage to drink controllably? Subsequent studies also found similar results.

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. In a 1988 U.S. Supreme Court decision on whether alcohol dependence is a condition for which the U.S. Veterans Administration should provide benefits^[11], 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." ^[12] The US Social Security Administration no longer makes disability payments to individuals for whom substance use disorders are a material aspect of their disability.

[edit] Miscellaneous

The disease model of alcoholism was first proposed by Dr. Benjamin Rush of Philadelphia in the early 1800s.
E. M. Jellinek has been called the father of the "modern" theory of alcoholism as a disease. However, there is considerable controversy and conflicting evidence over his claim that he ever received an earned doctoral degree^[13].