Vivian Marlowe
Alcoholism is a disease of nutritional excess, similar to obesity. While the understanding of alcoholism as a disease is widely accepted today, it wasn't always seen as such. Before alcoholism was recognised as a disease, it was considered a vice, a sin, and a matter for religion rather than medicine. The term alcoholism was first coined in 1852, but the idea that habitual alcohol drinking was a disease became more acceptable by the second half of the nineteenth century. The modern disease theory of alcoholism states that problem drinking is caused by a disease of the brain, characterised by altered brain structure and function.
| Characteristics | Values |
|---|---|
| Alcoholism viewed as a disease | Before the second half of the nineteenth century, alcoholism was not viewed as a disease. Many writers argued that it was a vice, a sin, and a matter for religion, not medicine. |
| Alcoholism as a mental disease | Scottish physician Thomas Trotter was the first to characterize excessive drinking as a mental disease or medical defect. |
| Alcoholism as an addiction | German physician Christoph Wilhelm Hufeland published a book on the "brandy plague" in 1802, stating that the "infection" with spirits makes it "inevitably necessary to drink ever more." |
| Alcoholism as a stimulant | Rush, Trotter, and Brühl-Cramer developed disease theories of alcoholism due to their shared interest in the Brunonian system of medicine, which classified alcohol as a stimulant of the vital force. |
| Alcoholism as a vice | While Swedish physician Magnus Huss coined the term "alcoholism" in 1849 and described the physical characteristics of habitual drinking, he regarded heavy drinking as a vice that destroys the nervous system. |
| Alcoholism as a choice | Some people still believe that using alcohol is a choice, despite scientific research showing that addiction is complex. |
| Alcoholism as a nutritional excess | Alcoholism is considered a disease of nutritional excess, similar to obesity, due to the excess amount of alcohol available in industrial society. |
| Alcoholism as a brain disease | Alcohol use disorder (AUD) is considered a brain disorder, with alcoholism causing altered brain structure and function. |
| Alcoholism as a treatable disease | The American Medical Association (AMA) designated alcoholism as a "major medical problem" in 1956 and urged treatment in general hospitals. |
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What You'll Learn
A vice or a sin
Alcoholism was not always seen as a disease requiring treatment. For a long time, it was considered a vice, a sin, and a moral failing. The idea that excessive drinking was a disease gained traction in the nineteenth century, but it was still debated whether it was a medical or religious issue.
The Scottish physician Thomas Trotter was one of the first to characterise excessive drinking as a mental disease or medical defect. In 1802, the German physician Christoph Wilhelm Hufeland published a book on the "brandy plague," arguing that drinking spirits created a necessity to drink more. This marked the beginning of a paradigm of addiction as a mental illness, although it took many decades for this view to gain widespread acceptance.
In the nineteenth century, Swedish physician Magnus Huss coined the term "alcoholism" and described it as a vice that destroys the nervous system. However, by the second half of the century, the idea that habitual drinking was a disease had become more acceptable, although writers and physicians still debated whether it was a vice or a sin outside the purview of medicine.
The American Medical Association (AMA) played a pivotal role in changing how alcoholism was viewed and treated. In 1956, the AMA designated alcoholism as a "major medical problem" and urged the hospitalisation and treatment of alcoholics. The AMA's work influenced the U.S. Supreme Court, which referenced the AMA's policies in its opinions and recognised alcoholism as a disease.
Despite these advancements, some still argue that alcohol use is a choice and criticise the characterisation of addiction as a disease as undermining personal responsibility. However, scientific research has revealed the complexity of addiction, and major health organisations and successful treatment facilities recommend the disease model.
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A mental disease
Alcoholism, or alcohol use disorder (AUD), has been recognised as a disease by major health organisations, including the American Medical Association (AMA), which declared it as an illness in 1956. However, this recognition is relatively modern, and the condition was previously seen as a moral failing or a criminal justice issue.
The idea that habitual alcohol drinking was a disease became more acceptable by the second half of the nineteenth century, although writers and religious figures still argued it was a vice, a sin, and a religious rather than medical issue. The term "alcoholism" was first coined in 1852, but its use is controversial as it is considered stigmatising and may discourage people from seeking treatment. The World Health Organization (WHO) has also described it as "a term of long-standing use and variable meaning", and its use is disfavoured by a 1979 WHO expert committee.
Despite the controversy surrounding the term, the concept of alcoholism as a disease has been explored by physicians and researchers for centuries. As early as 1802, German physician Christoph Wilhelm Hufeland published a book on the "brandy plague", describing the "infection" of spirits as something that makes it "inevitably necessary to drink ever more". This work marked the birth of a consistent "paradigm" of addiction as a mental illness, although it took many decades for this view to be accepted. Scottish physician Thomas Trotter also characterised excessive drinking as a mental disease or medical defect, and his views influenced other early disease theorists such as Rush and Brühl-Cramer.
In 1849, Swedish physician Magnus Huss systematically described the physical characteristics of habitual drinking and claimed it was a mental disease. Huss regarded heavy drinking as a vice that destroys the nervous system, and some historians argue that the idea that habitual drinking was a mental disease emerged even earlier. Today, alcohol use disorder (AUD) is the preferred clinical term, and it is considered a brain disorder that can be mild, moderate, or severe.
The modern disease theory of alcoholism states that problem drinking is caused by a disease of the brain, characterised by altered brain structure and function. Alcoholism is a complex condition with numerous risk factors and adverse effects, and it is often treated as a chronic disease that requires long-term treatment and periodic adjustments. This approach recognises that integrated treatment for co-occurring physical and mental health disorders is more likely to succeed than a single-minded approach. Alcoholism can severely impact physical and mental health and cause problems with family, friends, work, finances, and social life. It can also lead to health complications such as liver damage, high blood pressure, heart disease, pancreatitis, and an increased risk for several types of cancer.
While the disease model of alcoholism is widely accepted, there is still some debate. Some argue that using alcohol is a choice and that characterising it as a disease undermines a person's ability to choose. However, scientific research has shown that addiction is a complex condition that is far more complex than previously assumed.
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A stimulant of the vital force
Alcoholism, or alcohol addiction, was not always seen as a disease needing medical treatment. For a long time, excessive drinking was considered a vice, a sin, or a moral failing rather than a medical issue. However, there were early proponents of the idea that alcoholism was a disease.
As early as 1802, German physician Christoph Wilhelm Hufeland published a book on the "brandy plague," describing the "infection" of spirits as something that made it "inevitably necessary to drink ever more." This work is considered by some to be the birth of a consistent paradigm of addiction as a mental illness. Scottish physician Thomas Trotter also characterised excessive drinking as a mental disease or medical defect.
In the 19th century, the idea that habitual alcohol drinking was a disease became more acceptable, although it was still controversial, with many writers arguing against medicalisation. In 1849, Swedish physician Magnus Huss coined the term "alcoholism" in his book "Alcoholismus chronicus," and he is credited with being the first to systematically describe the physical characteristics of habitual drinking as a mental disease. However, Huss still regarded heavy drinking as a vice that destroys the nervous system.
The American Medical Association (AMA) played a pivotal role in changing how alcoholism was viewed and treated. In 1956, the AMA designated alcoholism as a "major medical problem," urging that alcoholics be admitted to general hospitals for care. This marked a significant shift in the medical community's acceptance of the disease concept of alcoholism. The AMA's involvement in court cases further solidified the idea that alcoholism was a disease and not a crime, influencing how the court system approached cases involving alcoholics.
Today, alcoholism is widely recognised as a chronic disease, characterised by impaired control over drinking, preoccupation with alcohol, continued use despite adverse consequences, and distortions in thinking. It is understood as a complex condition with numerous risk factors and adverse effects, requiring integrated treatment for co-occurring physical and mental health disorders. Alcohol use disorder (AUD) is the clinical term encompassing conditions such as alcohol abuse, dependence, addiction, and alcoholism. AUD is considered a brain disorder that can range from mild to severe and is characterised by altered brain structure and function.
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A brain disease
Alcoholism, or alcohol use disorder (AUD), has been recognised as a disease by many major health organisations, including the largest association of physicians, the American Medical Association (AMA). The AMA declared that alcoholism was an illness in 1956, and in 1991, it further endorsed the dual classification of alcoholism under both psychiatric and medical sections. This was a significant development that marked the acceptance of the 'disease concept of alcoholism' among the medical profession.
The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterised by altered brain structure and function. This theory is supported by studies on rats, which showed that specific strains of rats bred to prefer alcohol exhibited a physical dependency on it. Upon analysing the brains of these rats, researchers found differences in the chemical composition of certain areas of the brain compared to rats that were not bred for this preference. These studies suggest that certain brain mechanisms are more genetically prone to alcoholism, providing strong evidence for the genetic basis of alcoholism.
The characterisation of alcoholism as a disease is not new, with some historians arguing that the idea that habitual drinking was a mental disease emerged in the early 19th century. For example, in 1802, the prominent German physician Christoph Wilhelm Hufeland published a book on the "brandy plague", stating that the "infection" with spirits makes it necessary to drink more and more. This marked the birth of a consistent "paradigm" of addiction as a mental illness, although it took many decades for this view to be accepted. In 1849, Swedish physician Magnus Huss coined the term "alcoholism" in his book "Alcoholismus chronicus", systematically describing the physical characteristics of habitual drinking and claiming that it was a mental disease.
However, the idea that alcoholism is a disease was controversial, and it was not until the second half of the 19th century that this notion became more acceptable. Even then, many writers argued that alcoholism was a vice or a sin, falling under the purview of religion rather than medicine. The debate continued into the late 20th century, with the National Council on Alcoholism and Drug Dependence (NCADD) and ASAM defining alcoholism as "a primary, chronic disease characterised by impaired control over drinking" in 1992. Despite this, the term "alcoholism" is still considered stigmatising and is not favoured in professional and research contexts, with terms like “alcohol abuse”, “alcohol dependence”, or “alcohol use disorder” preferred.
Today, alcoholism is understood as a complex condition with numerous risk factors and adverse effects. It is considered a chronic disease that changes in severity and manifestations over time, requiring long-term treatment and periodic adjustments to treatment plans. Treatment for alcoholism often involves integrated treatment for co-occurring physical and mental health disorders, with ample research supporting this dual diagnosis approach. While some critics argue that treating addiction as a disease undermines personal choice, this view is controversial as it conflicts with evidence-based treatments and the success stories of individuals who have recovered using the disease model.
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A nutritional excess disease
Alcoholism, or alcohol use disorder (AUD), has been recognised as a disease by major health organisations, including the American Medical Association (AMA), which declared it an illness in 1956. However, this characterisation is relatively modern, and alcoholism was not always seen as a disease requiring treatment.
Historically, alcoholism was viewed as a vice or a sin, falling under the purview of religion rather than medicine. The idea that habitual alcohol consumption was a disease became more acceptable in the second half of the nineteenth century, with the publication of works by physicians such as Christoph Wilhelm Hufeland, Thomas Trotter, Rush, and C. von Brühl-Cramer. These early theories characterised excessive drinking as a mental disease or medical defect, with Hufeland describing the "brandy plague" and the "infection" of spirits that leads to a need to drink more.
The term "alcoholism" was first coined in 1852, and in 1849, Swedish physician Magnus Huss described it as a mental disease, though he still regarded it as a vice that destroys the nervous system. 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."
Alcoholism is now understood as a disease of nutritional excess, similar to obesity. Early humans ingested ethanol from the yeast-based fermentation of naturally occurring fruit sugars, which provided a source of nutrients. However, in modern industrial society, the excess availability of alcohol has led to problematic consumption. Alcoholism is a complex condition with numerous risk factors and adverse effects, and it is often challenging to overcome. It is characterised by altered brain structure and function, with genetic factors also contributing to an individual's predisposition to the disease.
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Frequently asked questions
Before alcoholism was considered a disease, it was believed to be a choice or a vice, a sin, and a matter for religion rather than medicine. Some believed alcoholism to be a mental disease or defect, while others believed it to be an "infection" or a plague.
The idea that habitual alcohol drinking was a disease became more acceptable by the second half of the nineteenth century. However, it was still debated, and many writers disagreed with this view. The term "alcoholism" was first coined in 1852, and the American Medical Association (AMA) designated alcoholism as a "major medical problem" in 1956.
Some critics argue that treating alcoholism as a disease undermines personal choice and provides individuals with a convenient justification for their behaviour. There is also a lack of consensus on the definition of alcoholism, and it is considered a stigmatizing term that may discourage people from seeking treatment. Alternative terms such as "alcohol use disorder" (AUD) are often used in clinical contexts.
