The Theoretical Debate on the Psychological And Medical Aspects of Habitual Drinking - Research Paper Example

 The Theoretical Debate on the Psychological And Medical Aspects of Habitual Drinking From the time alcoholism became tagged as a health menace as far back as the 18th century, there has never been a consensus as to what the proper treatment methodology should be used to make alcoholics kick the habit. The perennial debate boils down to the basic issue: Is alcoholism a biological disease or just a character or behavioral flaw? Only when this issue is resolved once and for all can the world determine with finality where to bring alcoholic patients for treatment and rehabilitation. If alcoholism is a biological disease, there can be no doubt that the problem is the exclusive domain of physicians. But if it is nothing but a character flaw, the rightful specialists to call in are the psychiatrists and similar professionals. In this clash of ideas, the disease concept of alcoholism seems to hold sway because of the relentless efforts of Alcoholics Anonymous to foster this belief. AA occupies an important place in any theoretical discussion of alcoholism because it serves as the rallying point for the concept that alcoholics carry a disease that needs medical treatment. It has been so effective in spreading this idea that a similar institution has been duplicated for alcoholics in many parts of the world. Another name that invariably comes up once the disease concept of alcoholism is mentioned is that of E. Jellinek who in 1946 published a study that has become the gospel of AA. The Jellinek study sets forth four propositions that uphold alcoholism as a disease: 1) heavy drinkers show the pattern of ever greater alcohol use leading to ever greater body, mental and social deterioration; 2) once this condition appears, it persists involuntarily; 3) medical expertise is needed to understand and relieve this condition; and 4) alcoholics, like epileptics, are not legally and morally responsible for their drinking and its consequences (Keller, M. & Doria, J., 1991). In this view, alcoholics cannot control drinking and require medical treatment because they exhibit the same symptoms of a regular disease: tolerance and withdrawal distress and loss of control or inability to abstain until alcoholics hit bottom as derelicts, turn insane or die. In support of the theory pushed by AA, behavioral and social scientists have come forward one after another, with the first endorsement offered by the American Medical Association (AMA) in 1957. This was followed in quick succession in the 1970s by the American Psychiatric Association, American Hospital Association, American Public Health Association, National Association of Social Workers, World Health Organization (WHO) and the American College of Physicians, which all listed alcoholism as a disease. A new kind of disease called “alcohol dependence syndrome” then entered the medical lexicon. As such, the updated definition set forth by the American Society of Addiction and National Council on Alcoholism and Drug Dependence is: “a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal, characterized by impaired control over drinking, preoccupation with alcohol as drug, and use of alcohol despite denial. Each of these symptoms may be continuous or periodic.” But in 1989, Stanton Peele raised his fists against AA and the above-named medical groups for supposedly fostering the myth of alcoholism for their own selfish interests. Peele argued that alcoholism is not a life-threatening occurrence since most drinkers can overcome the addiction on their own. He backed his argument with surveys showing that the general public objects to the disease concept and that even among doctors, the sentiment is not unanimous. In 1997, a survey conducted among physicians attending the International Doctors of Alcoholics Anonymous convention showed that 80 percent perceived alcoholism as a disease, which means 20 percent did not share this view. About the same period, a Gallup poll of ordinary Americans revealed that 90 percent believe alcoholism is not a disease and that treatment is a main concern of psychiatrists. Alcoholism is classified as a disease because it fits the description of a bodily malfunction. There is said to be a disorder in bodily structure or function, which can be physical or mental in nature. As in a regular disease, alcoholism also involves morbidity and follows a typical course and clear epidemiology (AMA, 1980). Among the biological causes cited by advocates of this concept relate to a metabolic dysfunction and hereditary influence. It is believed that people are susceptible to alcoholism when they metabolize their alcohol intake into a brain toxin called acetaldehyde. A high level of this morphine-like substance then induces an insatiable craving for alcohol. But Fingarette, H. dismisses this theory, saying it is implausible for any residual effects, physical or psychological, to be so overpowering as to override a sober person’s rational, moral and prudential inclination to abstain. As for the genetic factor, the disease theory is that if older members of the family drink, the compulsion runs in the blood. But the opposing view says no study ever showed a genetic pattern in a group of heavy drinkers and it is rare for a single family to have all members as alcoholics. Such an absence of scientific basis characterizes most arguments in support of the disease concept, which started as speculation based on an erroneous physiological premise (Levine, 1978) and on “religious perspectives, personal experiences and observations.” In fact, Robinson (1979) notes how some AA believers admitted that the disease concept is indeed scientifically flawed but that this is a practical way to encourage alcoholics to present themselves for rehabilitation and treatment. There is a social policy spawned by the disease theory that many find insidious because it serves to reward instead of reprimand people for drinking to excess. This policy provides alcoholics with special benefits in terms of employment, more health and civil rights if they are proven to be persistent and heavy drinkers. Instead of discouraging alcoholics from heavy drinking, it accomplishes just the opposite effect (Fingarette, H.). Other than this lack of scientific validity, Fingarette, H. also points out that the disease concept is also not helpful and compassionate since it “promotes a host of false beliefs and inappropriate attitudes, as well as harmful, wasteful and ineffective social policies.” He believes that alcoholics don’t lack control in the sense put forward by the disease theorists. A good number of experiments show that they can limit drinking in response to appeals to common sense, arguments, rules and regulations. People take to drinking as a way of coping with problems, or conforming to some group behavior, but they are perfectly capable of abstaining under the proper circumstances such as when they are in hospitals or in a no-drinking community norm (Paredes, et al., 1973). The view that alcoholism is merely a social problem holds that heavy drinking has many causes that vary from drinker to drinker. They include character, motivation, family environment, personal history, ethnic and cultural values and marital, educational and educational status. Thus, Heather & Robertson (1997) discards the disease theory in favor of social learning. Nackeraud, L. (2002) points to repeated findings that confirmed alcoholics can return to a normally controlled pattern of drinking. What could be the greatest scandal in the disease concept theory is the way it is used as a useful lie to persuade people to give themselves up for treatment, Nackeraud adds, saying this is a big waste of money and effort since a brief outpatient counseling has been shown to work just as well as a long and expensive stay in hospital. The reason why the medical community tends to perpetuate the disease theory is that doctors have negative views and stereotypical attitude towards alcoholism (Walsh, R., 1995) because most of their exposure to alcoholism involves dealing with cases of late-stage alcohol dependence. The Lancet journal in its November 1995 issue notes that medical schools think the same way, such that their field of study on alcoholism is limited to the end result of addiction or drug-related diseases. As a result, they produce doctors who lack knowledge on detection, prevention and treatment of alcohol abuse. As for the theory that alcoholism is a genetic disorder that runs in the family, this is dismissed as misleading and even dangerous (Fingarette, H.). He argues that the heaviest drinkers are those without alcoholism in their genetic background. For people who belong to families with some alcoholic members, the disease theory would likely influence them to drink to excess even if they had no inclination at the start because of the belief that they cannot go against the dictates of the genes anyway. Davies, D. (1962) raises the same issue against the “uncontrolled drinking” thesis in the disease concept. He points to an extensive study of alcoholics, which found that some were able to revert to controlled drinking. He then asked: How could someone suffering from a disease manage to control drinking? Later studies yielded more or less the same result, such as those conducted by Cahalan & Room (1974) and Rudy (1986), as cited in Hobbs, T. (1998), which showed that heavy drinkers differ. Some deteriorate into habitual drinking, while others improve or develop other problems. Many drinkers report no social problems, their drinking habit not a cause for concern among friends, families or colleagues. The idea that alcoholics are constantly drunk is false, Scheckit (1984) showed in his study, which followed a group of confirmed alcoholics as they drunk to excess for eight months and went “dry” for four months the rest of the year. In the succeeding years, one-third of the group of alcoholics placed under the study “matured out” into varying forms of moderate drinking or abstinence. Which means that not all alcoholics go through the pattern of deterioration set by Jellinek and AA on the disease concept. To resolve the conflict once and for all, Hobbs, T. (1998) suggests that a strategy similar in character to the campaign against smoking be adopted. This means that heavy drinking should be treated like chain smoking, which is not a biologically caused disease but a will power and control problem that can be reversed by appeals to good sense and the right social conditions. In the past 10 years, nicotine use has been reduced to a great degree because of a worldwide campaign to educate and persuade people on the unhealthy effects of tobacco smoke. In this effort, doctors played a big role in reducing mortality and morbidity from nicotine use through patient education. The same tack can be taken on the campaign against alcoholism. The main problem with the disease concept is that it was propounded and given currency by someone whose credibility is under question. E.M. Jellinek, the man acknowledged as father of the modern theory of alcoholism as a disease, has been called a liar and a fraud for claiming that he has a doctoral degree when evidence showed that he had not received any university degree at all (Wikipedia). This unavoidably reflects on the weak foundation of the disease theory and gives more credence to the notion that alcoholism is more of a social and attitude problem than a medical case. Along this line, Keller, M. & Doria, J. (1991) say that while alcoholism amounts to a bodily disorder it is not physically induced since it occurs in the central nervous system and is caused by the process of adaptation or learning. Alcoholism is in effect a behavior problem and not a lifelong disease. Peele, S. (1989) says by imposing the disease concept, its proponents “excuse people for their past, present and future irresponsibility.” But the fact remains that there is some grain of truth in the proposition that alcoholism is both a medical and social problem. As Hobbs, T. (1998) concludes in his thesis, the problem must be accepted as a bio-psychosocial problem with a strong genetic influence, obvious signs and symptoms, a natural progression and a fatal outcome if not treated. This could be the best attitude for the world to take, using medical intervention for extreme cases and “recreating living communities that nurture the human capacity to lead constructive lives (Peele, S., 1989)” in the more moderate instances of alcoholism. Bibliography: Crichley, M. (ed). “Butterworth’s Medical Dictionary.” 2nd ed., London, 1978. Davies, D. (1962). “Normal Drinking in Recovered Alcohol Addicts.” Quarterly Journal of Studies on Alcohol, 23: 94-104. Fingarette, H. (1988). “Heavy Drinking: The Myth of Alcoholism as a Disease.” Berkeley CA: University of California Press. Fingarette, H. (1991). “Alcoholism: The Mythical Disease.” In Society, Culture and Drinking Patterns Reexamined; Pittman, D. & White, H. (eds), New Brunswick, NJ: Rutgers University, 1991. Heather, N. & Robertson, I. (1981). “Controlled Drinking.” New York: Methuen. Hobbs, T. (1998). “Managing Alcoholism as a Disease.” Physician’s News Digest Inc., Pennsylvania Medical Society. Jellinek, E. (1960). “The Disease Concept of Alcoholism.” Yale Center of Alcohol Studies, New Brunswick, NJ: Hillhouse Press. Keller, M. (1991). “The Disease Concept of Alcoholism Revisited.” Journal of Studies on Alcohol, 37 (11): 1694-1717. Keller, M. & Doria, J. (1991). “On Defining Alcoholism.” Alcohol Health and Research World, Fall – 1991. Keller, M., McCormick, M. & Efron, V. “Dictionary of Words about Alcohol.” 3rd ed., New Brunswick, NJ: Rutgers University Press. Kurtz, E. (1986). “Alcoholics Anonymous and the Disease Concept of Alcoholism.” AA Grapevine 42:8 (January 1986). Logie, H. (ed., 1993). “A Standard Classified Nomenclature of Disease.” New York: Commonwealth Fund, 1933. Nackeraud, L. (2002). “The Disease Model of Alcoholism: A Kuhnian Paradigm.” Journal of Sociology and Social Welfare, June 1, 2002. Paredes, A. et al. (1973). “Loss of Control in Alcoholism: An Investigation of the Hypothesis, with Experimental Findings.” Quarterly Journal of Studies on Alcohol, 34: 1114-1161. Peele, S. (1989). “Diseasing of America: Addiction Treatment out of Control.” Lexington MA: Lexington Books. Read More