How is alcoholism a disease?

Alcoholism clearly represents problematic behavior; however, before alcoholism can be defined as a disease, the concept of disease needs to be understood more completely.

The concept fundamentally presumes a causal nature that results in a pathological state. The most common example that everyone can agree on is an infectious disease, where a foreign organism invades the body and causes a specific set of pathological processes to occur in the body that ultimately express themselves as various signs and symptoms. Signs are objective evidence that an outside observer can elicit through a physical examination and/or a set of tests such as blood or urine tests and/or imaging tests. Symptoms are the subjective manifestations of the disease that the individual feels. These include the aches, pains, and various discomforts that the person suffering from the disease feels. The discovery of specific treatments that killed the underlying organisms strengthens the disease concept, thus restoring the individual back to their normal state, free of signs and symptoms of that disease.

With technological advances, however, the concept of disease has changed. For example, why do some individuals develop a disease when exposed to a germ, whereas others do not? Genetics, local environmental conditions, and immune systems all became sources of study in understanding why some individuals carrying a particular organism are more prone to develop the disease. Disease is no longer a simple matter of finding a germ and killing it. Cause now entails not just the existence of the germ, but also multiple other factors that interact together with the germ to increase one's chances of developing a particular disease.

Genetic and environmental factors also play a role in making alcohol more or less lethal to any one particular individual

In that respect, alcohol can be viewed in the same manner as the germ theory of disease. It is the foreign substance that is the necessary but not the only factor in the development of alcoholism. Genetic and environmental factors also play a role in making alcohol more or less lethal to any one particular individual. Statistical chances for the development of the disease are well calculated in terms of amount and exposure to alcohol over time. A natural course develops in the development of the disease with repeated exposure over time. There is a consistent set of signs and symptoms that develop in the course of the disease. Physical exam findings and laboratory tests can support the diagnosis. Abstinence is the key to treatment, albeit the biggest obstacle because of the easy availability of the offending substance.

If you still believe that this analogy is wrong, consider a counterfactual example of a real disease. Tertiary syphilis causes behavior problems. It took years before the underlying cause was discovered, but it was well understood that it was transmitted through sexual contact. It was the result of "immoral behavior," and thus, a great deal of stigma was attached to it (as there still is). Before the discovery of penicillin, the psychiatric wards were populated with these patients. Nevertheless, only one third of individuals exposed to syphilis that are untreated develop tertiary syphilis. Thus, two thirds of individuals who were exposed to syphilis escaped both the fatal stages as well as the stigma attached to the infection. Why do some people develop tertiary syphilis while others do not? What factors, either inherent in the individual, the environment, or the organism, cause only a third to develop the fatal form? Certainly it is not a matter of choice, of right living, or of free will. It is, in the end, a matter of luck.

This example raises the unspoken fact that inherent prejudice exists in ascribing responsibility to individuals for their disease no matter what the disease is. This is especially true today with heart disease and cancer that unhealthy lifestyles and the increase in obesity cause, but even the seemingly most upright and healthy individuals can get sick. It is not unheard of to hear comments about someone who gets sick frequently as weak or "thin skinned," whereas others who amazingly avoid all illnesses are upright, moral, or positive thinkers. Our culture is rampant in applying moral values to disease and illness. In that regard, alcoholism is merely on a continuum in terms of people's attitudes and perceptions.

Susan's comment:

When my kids were little, I was amazed at how cruel the other kids could be. As Ben and his friends grew, they usually settled things around a keg of beer. Benny enjoyed that intangible thing that we all secretly wanted for our kidspopularity — so there were many parties and a lot of drinking. If the "guys" didn't get "wasted," they weren't cool. In the adult world, however, when it comes to alcoholism, cruelty is universal. People who never turn down a drink themselves can certainly be judgmental. These same people can't wait to scour the DWIs printed in the paper each day hoping to find someone they know. I wish I thought they were doing so to thank God that they haven't gotten "pinched." Instead, they get some sick kind of pleasure out of it and cant wait to get to work to see whether others have seen it. If it weren't so true, it would be funny. Also, I often hear discussions regarding the disease versus moral failing concept: "Well, insurance pays for it, so it must be a disease."

Proximate cause in evolutionary theory, the initial cause that changes the behavior of a biological system. Pulling one's hand from a fire is caused by a reflex arc in the nervous system and would be an example of a proximate cause.

Ultimate cause in evolutionary theory, the untimate cause for why a particular behavior evolves to serve an evolutionary purpose that has survival value.

Dopamine is the neurotransmitter in the brain that is most associated with reward. Alcohol increases dopamine both indirectly through other neurotransmitters as well as directly on dopamine itself.

Our health care system has redefined itself as dictated by the insurance companies, whose own newly created language refers to the patient as the "subscriber" and the doctor as the "provider. " The decision of what they cover and deny becomes the final arbiter of a "real" medical condition in many people's eyes. Insurance coverage provides for this "disease, "so it must be one!

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