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Is alcoholism a disease or just a bad habit?

Alcoholism has actually had a long history of debate over its exact nature. Although alcoholism was always considered a scourge, Thomas Trotter, a doctor at the turn of the 19th century, was one of the first to relate alcoholism to the increasing numbers of patients in asylums. Doctors working in the asylums were seeing increasing numbers of patients suffering from mental illnesses as a result of alcoholism. Trotter considered the heavy drinker to be ill. Brühl-Cramer, a German doctor, also considered heavy drinking to be a disease and used the term dipsomania to describe the disorder. He went on further to state that the loss of moral judgment was a consequence and not the cause of the disease. Lippich (1799-1845), an Austrian doctor who followed 200 drinkers for 4 years, produced the first statistical evidence of the effects of alcohol and established that alcoholics were more prone to illness and had fewer children and shorter lives than the general population. Benjamin Rush, the revolutionary hero, considered the father of American psychiatry, published An Inquiry into the Effects of Ardent Spirits on the Human Mind and Body in 1784. He wrote that alcoholism was due to a loss of the will and that although it may have begun as a matter of choice it eventually became a necessity.

Dipsomania an uncontrollable urge or craving for alcohol. This is an old expression for an alcoholic.

E.M. Jellinek, a New England physician, was the first to attempt a classification of alcoholism. He founded the Research Council on Problems of Alcohol in 1937 and undertook the first serious statistical study of the problem in the United States, eventually published in 1942. His study demonstrated the failure of prohibition and showed the complexity and variability of drinking habits within populations across the United States. He was instrumental in getting the World Health Organization (WHO) to accept his definition of alcoholism and to define it as a disease. Jellinek was the first to describe alcoholism as a dependence that interferes with all aspects of one's life, including a person's mental health, bodily health, personal relationships, and occupational functioning. Because of that, he felt medical care was necessary. Alcoholism became known as Jellinek's disease.

There has been a long-standing historical tradition that alcoholism is not simply a matter of choice because the consequences of the behavior are so self destructive that no one in his or her right mind would ever choose such a course of action. The emphasis has been consistently placed on the loss of control that the alcoholic experiences in his or her attempts to stop despite such obviously destructive consequences. This criterion defines the boundary between the normal and the pathological and not the amount or frequency of one's alcohol consumption. Mounting biological and psychological evidence continues to show that people struggling with alcoholism are different from the normal population.

There has been a longstanding historical tradition that alcoholism is not simply a matter of choice because the consequences of the behavior are so selfdestructive that no one in his or her right mind would ever choose such a course of action.

There are many ways to try to understand and dissect the behavior of an alcoholic, and no one doubts that the behavior is abnormal; however, calling alcoholism a disease suggests that it is the result of a specific pathophysiological process, which it clearly is not. Alcoholism is more likely the final end product of varying conditions, but so are obesity, heart disease, and cancer. Many people are quick to criticize the disease concept because the social consequences suggest that if we do not hold alcoholics responsible for their behavior then the "disease" provides an excuse for the lack of control and continued drinking. In fact, no evidence exists showing that people with alcoholism need an excuse to drink. Quite the opposite occurs — calling alcoholism a moral failing, a disease, or a disorder does not change the alcoholics self-destructive behavior and the problems associated with that behavior. It only changes the perceptions of people who have reasons to treat alcoholics as either ill or contemptible. As Shakespeare so eloquently wrote, "A rose by any other name smells just as sweet."

Susan's comment:

People often deem alcoholism as a lack of self-control even those who display the same characteristics in other areas. For example, Bens older sister has always struggled with her weight, but her brothers illness/behavior has still been very difficult for her; she is unable to hide her disappointment and anger. This, of course, hurts him, which elicits anger in me. Several months ago, after another of Bens relapses on an important occasion, she was very frustrated, leading her to be unkind, pompous, and judgmental. As she was berating her brother, I could feel the anger building in me. I asked her whether she thought that Ben had a lack of self-control. She exclaimed, "Yes, I certainly do." I then asked her to explain the difference between his lack of self- control with alcohol and her struggle with weight. Of course, she was furious because I had struck her where it hurt. This is only one example of how alcoholism has the potential to gut family relationships.

 
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