Is Alcoholism a Disease?

Disease: 1. Morbus; illness; sickness; an interruption, cessation, or disorder of body functions, systems, or organs, 2. A disease entity characterized usually by at least two of these criteria: a recognized etiologic agent (or agents), an identifiable group of signs and symptoms, or consistent anatomical alterations.©

From: Stedman’s Medical Dictionary, 24th Edition, p. 403.

The year was 1854; the place, New York City. "John," a homeless person, was walking the streets when he had another episode of severe dizziness, lethargy, and violent outcries, then collapsed on the walkway with convulsions. John was well known in the community for these episodes, but the citizens had finally become fed up with his antics and had him committed to the insane asylum, where he spent the rest of his days (which were few).

Since this is an article about "alcoholism," you probably have assumed that John was an alcoholic having a withdrawal episode. Actually he was suffering from hypoglycemia, a now well-recognized metabolic dysfunction that has effective treatment protocols, though no specific cure.

Had the thought that John may be suffering a disease process even entered the minds of those citizens? One mustn’t blame the people of the time for their ignorance—they simply didn’t know better. However, with the improved scientific tools at our disposal, we are in a position to be more enlightened.

Today, there is an active debate about whether alcoholism is an actual disease or simply a lack of will power on the part of the afflicted person. In some religious circles, the alcoholic is demonized; much like Galileo when he suggested that the Earth is not the center of the universe.

Let us examine alcoholism in a purely logical fashion, not in the judgmental way that society often does.

Major symptoms of alcoholism include an intolerable craving for alcohol. The exact etiology of this is unclear. Why do some people have this craving for alcohol, whereas others do not? There are theories which claim that an underlying genetic process in the digestion of ethanol into simple sugars means that the alcoholic requires it for normal functioning of the body, but this is far from proven. However, just because we do not know all of the mysteries of this process does not exclude it from being a disease. If this were so, then since the scientists of the time did not understand or recognize hypoglycemia, then John did not have a disease—he was just evil. A patently ridiculous statement.

With continued use of alcohol, symptoms of withdrawal become apparent, such as shaking, nausea, vomiting, seizures, delirium, as well as other disorders.

Signs, which are what the physician finds on examination, include altered mental status (even when not acutely intoxicated), tremors or shaking, elevated blood pressure, and flushing of the face, as well as a large number of other measurable physical symptoms.

It is important to note that diabetics who constantly neglect their disease process have signs such as retinopathy (degeneration of the retina of the eyes), kidney failure, and so on, similar to an alcoholic.

When collecting data from an alcohol for a family map known as a genogram, there is almost always a family tree full of alcoholics. However some claim that this is simply a case of "monkey see—monkey do;" or in other words, it is simply a learned trait. The weakness of this statement is demonstrated by numerous studies of identical twins of an alcoholic heredity, separated at birth, one placed in an alcoholic home, and the other in a sober household. In every study, in a high percentage of cases, both children became alcoholic. So from these studies, as well as studies performed on monkeys, it appears that there is a genetic link.  With all of the research being performed in genetic mapping, perhaps a common gene, or more likely a group of genes, will be discovered in alcoholics.

The drinking of spirits is not the only problem alcoholics have to deal with; there is also the incredible apparent loss of rational thought, even when sober. It is often the case that an alcoholic who has not had had a drink in several months will still act the same as he did when actively using. He is referred to as a "dry drunk." His thinking often becomes "black or white," "all or nothing." Grandiosity is also a common symptom—the thought, "I can do anything" runs rampant, as is impulsivity, acting on thoughts without thinking. These patterns of thinking are very reproducible from alcoholic to alcoholic.

Depression is now recognized as a clinical disease with effective treatments. Clinical depression has a set of specific symptoms, such as unexplainable sadness, insomnia, poor appetite, among others. The scientific community is constantly finding new etiologies to explain this complex problem, with new treatments being developed almost daily, whereas only sixty years ago the only answer to the problem was to "pick yourself up by the bootstraps and get on with life," or in other words, exert more will power. The answer to alcoholism is far more complex than simply to stop drinking. The answer lies in the biochemistry of the brain, where much research is being performed.

Is alcoholism a disease? With a specific set of symptoms, most notably an uncontrollable craving of alcohol whose exact etiology is unknown but is reproducible from one afflicted person to another, as well as the other symptoms and signs listed above; and with the definition of a disease clearly spelled as having identifiable and consistent symptoms, it would appear that alcoholism is indeed a disease and needs to be treated as such. It is time to stop the prejudice that society directs at these people, and treat it for what it is: a disease rather than a spiritual deficiency.

By Dr. Dale, author of Faith Love, and Overcoming: My Battle With Addiction,  © Copyright 2001 American Book Publishing.

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