Theo Nash
Alcoholism has been considered a disease for several decades, with the American Medical Association (AMA) first classifying it as such in 1956. Since then, the medical community has increasingly viewed alcoholism as a chronic disease, similar to conditions like high blood pressure and diabetes. This shift in perspective has been reflected in the work of health and addiction experts, who have treated alcoholism as a disease with periods of remission and relapse. Despite this broad consensus, some debate remains, with critics arguing that alcoholism is a choice or a moral deficiency rather than a disease. However, scientific research has revealed the complex nature of addiction, influenced by factors such as genetics, family history, and environment. The disease theory of alcoholism proposes that those affected are unable to return to 'normal' drinking and should aim for total abstinence. While this theory has been challenged, the concept of alcoholism as a disease has gained traction, with organizations like the National Institute on Alcohol Abuse and Alcoholism (NIAAA) advocating for this perspective.
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What You'll Learn
Alcoholism as a disease: a historical perspective
Alcoholism has been considered a disease for several decades, with the American Medical Association (AMA) officially classifying it as such in 1956. This classification has had a significant impact on how alcoholism is viewed and treated, with most health and addiction experts now considering it a chronic disease. Despite this broad consensus, some debate and resistance to the disease theory of alcoholism persist.
The historical perspective on alcoholism as a disease is complex and has evolved over time. As early as 1917, the AMA took a stance against the use of alcoholic liquor as a therapeutic agent, declaring it without "scientific basis". In 1921, the AMA addressed the misuse of prescription alcohol by some medical professionals, bringing reproach upon the profession. These early statements recognised the potential harm associated with alcohol but did not explicitly characterise alcoholism as a disease.
The first major step towards recognising alcoholism as a disease came in 1956 when the AMA designated it as a "major medical problem". This was a pivotal moment, marking the acceptance of the 'disease concept of alcoholism' among the medical profession. The following year, in 1957, the AMA urged that alcoholics be admitted to general hospitals for care, acknowledging the need for medical treatment.
In the latter half of the 20th century, the disease concept of alcoholism gained further traction. The National Council on Alcoholism and Drug Dependence (NCADD) and ASAM defined alcoholism in 1992 as "a primary, chronic disease characterised by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking." This definition emphasised the chronic nature of alcoholism and its impact on various aspects of an individual's life.
While the disease theory of alcoholism has gained widespread acceptance, it has also faced challenges and criticism. Some critics have disputed the idea that problem drinkers cannot return to controlled drinking, presenting empirical evidence to support their argument. Additionally, within the medical community, there has been a shift in terminology, with terms like "alcohol abuse", "alcohol dependence", or "alcohol use disorder" favoured over "alcoholism" in professional and research contexts.
Despite the ongoing debates and evolving terminology, the recognition of alcoholism as a disease has had a significant impact on public perception and treatment approaches. It has led to a greater understanding of the genetic, neurobiological, and psychosocial foundations of alcoholism, as well as the development of various treatment options. Today, alcoholism is widely recognised as a complex condition requiring ongoing medical attention and support.
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Alcoholism: a disease or a choice?
Alcoholism has been a topic of debate for decades, with some considering it a disease and others viewing it as a choice or a moral failing. The term "alcoholism" itself is loosely defined and is more commonly used among the general public than in professional or research contexts, where terms like “alcohol abuse,” “alcohol dependence,” or “alcohol use disorder” (AUD) are preferred.
The Case for Alcoholism as a Disease
The American Medical Association (AMA) played a pivotal role in shaping the perception of alcoholism as a disease. In 1956, the AMA designated alcoholism as a "major medical problem," urging hospitals to admit alcoholics for care. This marked the beginning of the "disease concept of alcoholism." The National Council on Alcoholism and Drug Dependence (NCADD) and ASAM defined alcoholism in 1992 as:
> "...a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking."
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) also asserts that alcoholism is a disease. They describe how an alcoholic's craving for alcohol can be as strong as the need for food or water, and they continue drinking despite serious consequences. Like other chronic diseases, alcoholism is characterized by periods of remission and relapse and tends to worsen over time. Additionally, research has identified a genetic predisposition to alcoholism, with children of alcoholic parents being more likely to become alcoholics themselves.
The Case for Alcoholism as a Choice
Despite the growing acceptance of alcoholism as a disease, some healthcare professionals and sociologists argue that it does not fit the disease model and is resistant to standard medical treatment. They view alcoholism as a willpower or conduct problem, believing that alcoholics have a choice and should be held accountable for their actions. This perspective considers alcoholism as a behavioural problem, a moral deficiency, or a result of personal choice rather than a disease. Critics of the disease theory point to cases where formerly dependent drinkers have returned to controlled drinking, challenging the idea that problem drinkers cannot return to normal drinking patterns.
Legal Perspective
The legal system has also grappled with the question of whether alcoholism is a disease or a choice. The U.S. Supreme Court has referenced AMA policies and amicus briefs in several cases to determine how to handle alcohol-related offences. In the 1966 case of *Budd v. California*, Justice Abe Fortas dissented, questioning the constitutionality of punishing someone with alcoholism rather than voluntary overindulgence. In 1968, the court heard *Powell v. State of Texas*, where a man argued that punishing him for his alcoholism would be cruel and unusual. While the court ultimately allowed him to be punished, the justices acknowledged the AMA's designation of alcoholism as a disease and the medical profession's acceptance of the disease concept.
While the debate surrounding alcoholism as a disease or a choice persists, there is growing recognition within the medical and scientific communities that it is a complex condition. Alcohol use disorder (AUD) is now widely recognised as an incurable brain disorder that can range from mild to severe. The understanding of alcoholism has evolved over the past century, and ongoing research continues to enhance our knowledge of its aetiopathology and treatment options.
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Alcoholism and the medical community
Alcoholism and its effects on the human body have been a topic of interest for the medical community for a long time. The American Medical Association (AMA) classified alcoholism as a disease in 1956. In 1987, the AMA classified addiction as a disease as well. Since then, most experts, including addiction medicine specialists and neuroscientists, have come to a consensus that addiction should be considered a disease.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) supports and conducts biomedical and behavioural research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. The official NIAAA position is that "alcoholism is a disease." The NIAAA further states that "the craving that an alcoholic feels for alcohol can be as strong as the need for food or water." Alcoholism is also characterised by increasing alcohol consumption to achieve the same effects (tolerance) and physical dependence, leading to withdrawal symptoms upon alcohol cessation.
There is a broad consensus within the medical and scientific communities regarding alcoholism as a disease state. For example, the American Society of Addiction Medicine (ASAM) defines addiction as a chronic brain disorder rather than a behavioural problem, moral deficiency, or a product of personal choice. The ASAM's definition is supported by research that has shown that addiction is far more complex than previously assumed. Studies on children separated from their alcoholic biological fathers demonstrate that those children are more likely to become alcoholic, even when raised by non-alcoholic parents. This provides evidence for a genetic basis for alcoholism.
Despite the broad consensus, there is still some debate within the medical community. Some critics have used evidence of controlled drinking in formerly dependent drinkers to dispute the disease theory of alcoholism. In addition, some healthcare professionals view alcohol addiction as a willpower or conduct problem rather than a disease. They argue that alcoholism does not follow the model of a typical disease and is not amenable to standard medical treatment. Furthermore, the term "alcoholism" is not currently favoured in professional and research contexts, with terms like "alcohol abuse," "alcohol dependence," or "alcohol use disorder" being preferred.
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Alcoholism's impact on health
Alcoholism, or alcohol abuse, has been considered a disease for several decades. In 1956, the American Medical Association (AMA) designated alcoholism as a "major medical problem", urging that alcoholics be admitted to general hospitals for care. The official position of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is that "alcoholism is a disease". The NIAAA funds approximately 90% of all research on the causes, consequences, treatment, and prevention of alcoholism in the United States.
Despite this, the term "alcoholism" is not currently favored in professional and research contexts, with terms like alcohol abuse, alcohol dependence, or alcohol use disorder being preferred. This is partly because the term "alcoholism" is considered to be poorly defined and imprecise.
Regardless of the terminology used, excessive alcohol consumption can have a detrimental impact on health in numerous ways. Firstly, it can disturb the endocrine system, disrupting hormones that maintain the body's stability and health. This can lead to various health conditions, including thyroid diseases, abnormal cholesterol levels, reproductive dysfunction, stress intolerance, and diabetes.
Secondly, alcohol use is associated with an increased risk of developing cancer, including head and neck cancers, and breast cancer. The more alcohol a person consumes, particularly over time, the higher their risk of developing an alcohol-associated cancer. Even those who binge drink or have just one drink per day have a slightly increased risk of certain cancers.
Thirdly, sustained alcohol consumption can damage the central and peripheral nervous systems, resulting in a wide range of immunologic defects and a tendency to accidental injury due to skeletal fragility. Additionally, women are more susceptible to the long-term complications of alcohol dependence, including brain, heart, and liver damage, and they have a higher mortality rate from alcoholism than men.
Finally, excessive alcohol use can negatively impact mental health, leading to conditions such as depression and anxiety, as well as causing learning and memory problems, including dementia. It can also contribute to relationship problems with family and friends.
Overall, alcohol consumption can have far-reaching consequences on health, and reducing alcohol intake can lower the risk of these adverse effects.
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Alcoholism treatment and recovery
Alcoholism, or alcohol dependence, has been considered a disease for many years, with the American Medical Association (AMA) designating it as a "major medical problem" as early as 1956. Despite this, there is still debate and resistance among healthcare professionals and sociologists regarding the disease classification of alcoholism, with many considering it a willpower or conduct problem.
Treatment and Recovery
- Medication: The U.S. Food & Drug Administration has approved medications such as naltrexone, acamprosate, topiramate, and gabapentin to reduce cravings and treat alcohol use disorder. However, it is important to consult a healthcare provider before taking any medication.
- Mutual-Support Groups: Alcoholics Anonymous (AA) and other 12-step programs provide valuable peer support for individuals quitting or cutting back on their drinking. These groups offer a sense of community and understanding, which can be crucial during recovery.
- Behavioral Therapies: These therapies help individuals develop skills to identify and manage triggers, such as stress or exposure to certain people or places associated with past drinking. Cognitive-behavioral therapy is one approach that can help change the individual's relationship with alcohol.
- Exercise: Physical activity is an effective way to manage stress and channel energy positively. It can also help reduce cravings and improve overall health and well-being.
- Support Networks: Building a strong support system is essential. This can include family, friends, therapists, or support groups who understand the individual's situation and can provide encouragement and accountability.
- Online Programs: E-health tools and online self-guided programs can be effective in helping individuals overcome alcohol problems. These programs offer flexibility, privacy, and easy access to resources and support.
- Medical Detox: For individuals with severe alcohol dependence, medically supervised detoxification is crucial. Withdrawal from alcohol can be life-threatening, and medical professionals can provide medications and support to make the process safer and less distressing.
It is important to note that recovery is a journey, and setbacks or relapses may occur. Persistence and continued engagement with treatment are key. Additionally, treatment should be tailored to the individual's specific needs, and a healthcare provider can help determine the best course of action.
In addition to these treatment options, it is worth noting that the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in the US conducts and funds research on alcoholism and alcohol-related problems. Their official position is that "alcoholism is a disease," and they provide resources and support for those affected.
While the debate on the disease classification of alcoholism continues, the impact of alcohol abuse on individuals, families, and society is undeniable. Seeking help and support is a crucial step toward recovery and a healthier life.
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Frequently asked questions
Alcoholism has been considered a disease for over 60 years. The American Medical Association (AMA) first classified it as a disease in 1956.
No, there is still some debate within the medical community. Some doctors view alcoholism as a willpower or conduct problem.
Considering alcoholism a disease means that those afflicted with it can be admitted to hospitals for care and treatment. It also means that alcoholism can be viewed similarly to other chronic diseases such as high blood pressure and diabetes, which have periods of remission and relapse.
