Mason Delacroix
Alcoholism, or alcohol addiction, is a complex phenomenon with multiple perspectives and formal definitions. While some consider it a disease, others view it as a social or psychological problem. The disease theory of alcoholism proposes that it is a chronic brain disease characterised by compulsive alcohol seeking and impaired control. This model is supported by the American Medical Association (AMA), which declared alcoholism an illness in 1956 and endorsed its dual classification under both psychiatric and medical sections in 1991. However, critics argue that the disease concept reduces personal responsibility and stigma, potentially increasing alcoholism and drug abuse. They also highlight the occurrence of controlled drinking and relapse, challenging the idea of alcoholism as a loss-of-control disease. The understanding of alcoholism as a disease has evolved, with early mentions in ancient times and the coining of the term alcoholism in 1849, and continues to be a subject of ongoing research and debate.
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What You'll Learn
Alcoholism as a brain disease
Alcoholism, or alcohol use disorder, is often considered a disease, specifically a brain disease, by many physicians and medical organisations. The American Medical Association (AMA), the largest association of physicians, declared alcoholism an illness in 1956 and endorsed its dual classification under psychiatric and medical sections in 1991.
The disease theory of alcoholism suggests that it is a chronic problem that requires abstinence. This theory is based on the extent of neuroadaptation and impaired control. Alcoholism is characterised by symptoms such as impaired control over alcohol consumption, compulsive thoughts about alcohol, and distorted thinking. The progression of the disease is often subtle and extended, with the alcoholic themselves sometimes failing to notice the loss of control. This results in denial, which is an almost universal symptom of the disease.
The brain disease model of addiction proposes that repeated heavy drinking develops tolerance and disrupts the normal balance of the brain's dopamine and stress neurotransmitters. The brain's reward processing system is activated by alcohol, producing a pleasurable surge of dopamine in the basal ganglia, an area responsible for controlling reward systems and learning based on rewards. With continued alcohol use, nerve cells in the basal ganglia reduce their sensitivity to dopamine, resulting in a reduced ability to feel pleasure from ordinary pursuits like eating or socialising. This disruption of the reward system can lead to a decrease in enjoyment from activities when not drinking, further reinforcing the addiction.
Chronic drinking can also "train" the brain to associate pleasure with various cues related to drinking, such as the people, places, and habits connected to alcohol consumption. This association makes it challenging for individuals to stop thinking about drinking. Additionally, alcohol can produce chemical imbalances in specific neurocircuits and impact brain regions involved in motivation, memory, decision-making, impulse control, attention, and other cognitive functions. These brain changes can make it increasingly difficult for individuals to stop drinking without assistance.
However, it is important to note that some physicians, scientists, and addiction experts reject the disease theory of alcoholism. They argue that the disease concept removes stigma and personal responsibility, potentially increasing alcoholism and drug abuse. Some believe that alcoholism is a social or psychological problem rather than a disease. The medicalization of alcoholism is controversial, and the sociological definition regards it as a symptom of social deviance.
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Addiction as a mental illness
Addiction is a complex condition and a brain disease that is manifested by compulsive substance use despite harmful consequences. The American Medical Association (AMA) considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterised by compulsive drug-seeking behaviour and use despite often devastating consequences".
The largest association of physicians, the AMA, declared that alcoholism was an illness in 1956. In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections. Under the model of alcoholism, alcohol use disorder is viewed as a chronic problem for which abstinence is required. A brain disease model of addiction, based on the extent of neuroadaptation and impaired control, is the main position advanced for proposing a disease model of alcohol use disorder. However, some addiction experts and alcohol researchers reject the disease model, arguing that it removes stigma and personal responsibility, thereby increasing alcoholism and drug abuse.
The concept of addiction as a mental illness was first introduced by German physician Christoph Wilhelm Hufeland in 1802, who wrote about the "brandy plague" and the "infection" with spirits that makes it "inevitably necessary to drink ever more". This was further supported by German-Russian physician C. von Brühl-Cramer, marking the birth of a consistent "paradigm" of addiction as a mental illness.
Alcoholism is the continued drinking of alcohol despite it causing problems, and it often reduces a person's life expectancy by around ten years. It is considered a disease of nutritional excess, similar to obesity. Alcohol is often used for self-medication for conditions like anxiety, and early humans regularly ingested ethanol made from yeast-based fermentation of naturally occurring fruit sugars. The ability to produce an abundant amount of offspring increases in the low concentration presence of ethanol, and humans have the metabolic equipment to have hormetic advantages from ethanol at low concentrations.
Treatment for addiction and alcoholism often involves behavioural therapies such as cognitive behavioural therapy, contingency management, and motivational interviewing, which help individuals build coping skills and learn to manage co-occurring substance use and mental disorders. Medications can also be used to treat addictions to opioids and alcohol and lessen the symptoms of many other mental disorders.
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Alcoholism as a social or psychological problem
Alcoholism, or alcohol use disorder, is a complex condition that encompasses both social and psychological dimensions. It is characterised by a pattern of disordered drinking that leads to significant distress and negative consequences in various aspects of life.
Social Impact of Alcoholism
Alcoholism has far-reaching social implications, affecting not only the individual but also their families, communities, and society as a whole. One of the most profound social impacts of alcoholism is the disruption of interpersonal relationships. Alcohol can alter a person's behaviour, impair their judgement, and increase their propensity for risky behaviours. This can lead to conflict, violence, and the breakdown of relationships with family, friends, and romantic partners. Children of parents with alcoholism are also at risk of emotional and psychological problems and are more likely to develop drinking problems later in life.
Alcoholism also carries significant economic costs. The healthcare expenses, lost work productivity, and criminal justice costs associated with alcohol abuse amount to billions of dollars annually in the United States alone. These financial burdens can have long-lasting social impacts, affecting families, communities, and the nation's socioeconomic reality.
Psychological Impact of Alcoholism
Alcoholism is closely tied to mental health. People with underlying mental health conditions, such as depression, PTSD, or ADHD, are at an increased risk of developing alcohol use disorder. Substance use disorders frequently co-occur with mental illness, and alcohol may be used as a coping mechanism for trauma or other psychological disorders. The relationship between alcohol and mental health is complex and bidirectional, with alcohol abuse potentially exacerbating mental health issues and vice versa.
Treatment Approaches
Treating alcoholism requires addressing both the social and psychological aspects of the disorder. Treatment centres should have integrated approaches that tackle mental and physical health, family dynamics, and social factors contributing to the disorder. Medically assisted detox, individual and group therapy, family therapy, and aftercare services are all crucial components of effective treatment.
Relapses are common during recovery, and ongoing support is essential. Treatment providers should connect patients with mental health professionals, housing support, and peer support groups to ensure a comprehensive approach to managing alcohol use disorder.
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Alcoholism as a disease of nutritional excess
Alcoholism, or alcohol addiction, has been defined by some as a disease. The largest association of physicians, the American Medical Association (AMA), declared that alcoholism was an illness in 1956. However, the disease model of alcoholism is not universally accepted, with some addiction experts and alcohol researchers rejecting it.
One perspective on alcoholism is that it is a disease of nutritional excess, similar to obesity. Early humans ingested ethanol, a byproduct of yeast-based fermentation of naturally occurring fruit sugars. In modern industrial societies, however, there is an excess of alcohol, and this consumption can become problematic. Alcohol itself is a toxin and even small amounts can cause fatty liver; long-term alcohol use can lead to hepatitis and cirrhosis.
Alcohol abuse creates an internal environment that predisposes individuals to malnutrition. It competes with limited nutritional resources that would normally nourish the body. Alcohol is a diuretic, increasing urine output and leading to the loss of water-soluble minerals such as zinc, magnesium, and potassium. Zinc deficiency, for example, interferes with taste and smell, further limiting dietary intake. Alcohol displaces calories from nutrient-dense foods with empty calories, and larger amounts suppress hunger, doubly depriving the body of nutrients. Alcohol also interferes with the absorption and storage of certain vitamins.
Chronic heavy drinkers are often at least mildly malnourished, and severe cases may result in hospitalization. Restored nutrition is a critical aspect of treatment for alcohol use disorders. Improving diet and nutrition can help support brain function, which is essential for the willpower needed in the recovery process.
In summary, the perspective of alcoholism as a disease of nutritional excess highlights how excessive alcohol consumption can lead to malnutrition and nutrient deficiencies, impacting the body's ability to absorb and utilize nutrients effectively. This view aligns with the broader disease model of alcoholism, which characterizes it as a chronic condition requiring abstinence and comparable to other substance addictions.
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The sociological definition of alcoholism
Alcoholism, or alcohol addiction, is a complex and multifaceted phenomenon with a range of definitions and interpretations. While the medical community largely views alcoholism as a disease, there are differing perspectives, including sociological definitions that offer alternative understandings of this condition.
This perspective challenges the medicalization of alcoholism, arguing that the loss of control associated with drinking does not consistently hold across all situations and cultures. Alcoholics may sometimes resist the urge to drink or consume alcohol in a controlled manner, which contradicts the binary nature of the medical model that suggests alcoholism is either present or absent.
The sociological perspective also highlights the role of social and environmental factors in alcoholism. It views alcoholism as influenced by cultural norms, societal expectations, and the availability and accessibility of alcohol within a particular social context. This understanding of alcoholism as a social issue leads to a focus on prevention through societal interventions such as increasing the legal drinking age, restricting alcohol advertising, taxation, and educational campaigns, and addressing underlying stress and anxiety that may contribute to self-medication with alcohol.
While the sociological definition provides valuable insights into the social dimensions of alcoholism, it is important to recognize that alcoholism is a complex condition with biological, psychological, and social components. The medical community's classification of alcoholism as a disease has led to the development of treatment approaches, including abstinence and brain disease models, that aim to address the physiological and psychological aspects of the disorder.
In conclusion, the sociological definition of alcoholism offers a critical perspective by viewing it as a symptom of social deviance rather than a disease. This understanding highlights the role of societal factors and cultural contexts in shaping perceptions of alcoholism. However, it is essential to acknowledge the multifaceted nature of alcoholism and the validity of medical definitions that have informed treatment approaches for this complex disorder.
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Frequently asked questions
The disease theory of alcoholism states that alcoholism, or alcohol use disorder, is a disease characterised by symptoms such as impaired control over alcohol, compulsive thoughts about alcohol, and distorted thinking.
The largest association of physicians, the American Medical Association (AMA), declared that alcoholism was an illness in 1956. There is a broad consensus regarding alcoholism as a disease state within the medical and scientific communities. Alcoholism has been found to be 50-60% genetically determined, and alcohol is a drug that affects the brain's information processing system.
Some physicians, scientists, addiction experts, and sociologists reject the disease theory of alcoholism. Critics argue that the disease concept removes stigma and personal responsibility, increasing alcoholism and drug abuse and the need for treatment. They also point out that alcoholics can sometimes resist the impulse to drink or drink in a controlled way, which is inconsistent with the medical model.
The concept of alcoholism as a disease appears to be rooted in antiquity. The Roman philosopher Seneca classified it as a form of insanity. In 1802, German physician Christoph Wilhelm Hufeland published a book on the "brandy plague", marking the birth of a consistent paradigm of addiction as a mental illness. The term "alcoholism" was first used in the classical essay "Alcoholismus Chronicus" (1849) by Swedish physician Magnus Huss. In 1956, the AMA declared alcoholism an illness.
